1. Focus on Pharmacology Essentials for Health Professionals
Jahangir Moini, MD, MPH
Chapter 27 Effects of Drugs on Eye Disorders

2. Beta-Blockers: Uses reduce elevated intraocular pressure (IOP)
Used to treat intraocular hypertension and chronic open-angle glaucoma

3. Beta-Blockers: Adverse Effects
Common: local, mild ocular stinging, dry eyes, tearing, blurred vision, eye irritation
Serious: thyrotoxic crisis in patients with hyperthyroidism

4. Beta-Blockers: Contraindications
Contraindicated in angle-closure glaucoma, sinus bradycardia, cardiogenic shock
Safety during pregnancy and in children younger than 18 years not established
Cautious use in heart failure or diabetes and during lactation

5. Beta-Blockers: Patient Information
Advise patients to report unusual or significant changes in pulse rate.
Instruct patients to follow dosing regimen exactly and to not stop drugs abruptly.

6. Carbonic Anhydrase Inhibitors: Uses
Work by decreasing formation of aqueous humor
Used to treat glaucoma

7. Carbonic Anhydrase Inhibitors: Adverse Effects
Common: skin rashes, kidney stones, anorexia, electrolyte imbalances
Serious: aplastic anemia

8. Carbonic Anhydrase Inhibitors: Contraindications
Contraindicated in patients with chronic noncongestive angle-closure glaucoma; renal or hepatic dysfunction
Safety during pregnancy or lactation not established.
Cautious use in diabetes, gout, asthma

9. Carbonic Anhydrase Inhibitors: Patient Information
Tell patients to discontinue drug and report eye irritation, infection, or systemic hypersensitivity.
Some of these drugs may cause drowsiness.

10. Bilberry for Eye Health
Bilberry has been used to improve night vision and to prevent cataracts, macular degeneration, and glaucoma, and to prevent and treat diabetic retinopathy and myopia.
Must be avoided in pregnancy and lactation.

11. Direct-Acting Miotics: Uses
Work by increasing drainage of aqueous humor from anterior eye cavity
Used to treat open-angle and angle-closure glaucoma

12. Direct-Acting Miotics: Adverse Effects
Headache
Pupil constriction

13. Direct-Acting Miotics: Contraindications
Contraindicated in contact allergy, cataract, retinal detachment, and depression
May interact with MAO inhibitors

14. Direct-Acting Miotics: Patient Information
Advise patients to use caution during nighttime driving and in performing hazardous activities in poor light.

15. Indirect-Acting Miotics: Uses
Produce severe miosis (contraction of the pupil)and muscle contractions due to decreased resistance to aqueous outflow
Used to treat open-angle glaucoma

16. Indirect-Acting Miotics: Adverse Effects
Common: lacrimation, burning conjunctivitis, conjunctival thickening, nausea, vomiting, diarrhea, difficult breathing, urinary incontinence, salivation, fainting
Serious: retinal detachment

17. Indirect-Acting Miotics: Contraindications
Contraindicated in patients with acute inflammatory disorders of eye, during pregnancy and lactation
Cautious use in chronic angle-closure glaucoma and myasthenia gravis

18. Indirect-Acting Miotics: Patient Information
Advise patients that aching around the eyebrows or temporary burning and stinging may occur initially but usually disappears with continued use.
Advise patients to wear sunglasses.

19. Eyedrops and Contact Lenses
Patients with contact lenses must remove them and leave them out for at least 15 minutes after administering eyedrop preparations.

20. Cycloplegics
Used mostly for eye exams and eye surgery to cause pupil dilation
Adverse effects: blurred vision, photophobia, cycloplegia, eye dryness
Contraindications: angle-closure glaucoma, ulcerative colitis, tachycardia, acute bleeding, myasthenia gravis (muscle weakness)

21. Cycloplegics (continued)
Patient information: advise patients to drive carefully and wear sunglasses; report allergic reaction.