1. Chapter 31 Drugs Used to Treat Eye Disorders

3. Box 31-1 The Eye: Structures and Functions: Eye has 3 layers
sclera: white of eye, outer layer
choroid: second layer, made of blood vessels, ciliary muscle and iris (give eye color), opening in middle of iris is pupil
miosis: Narrowing of pupil
mydriasis: dilation (widening) of pupil
retina: inner layer, has receptors for vision and nerve fibers of optic nerve
light enters eye through cornea
light rays pass to the lens, which lies behind pupil
light then reflected to retina
light is carried to brain by optic nerve
aqueous chamber: separates cornea from lens, filled with fluid called aqueous humor, helps keep shape and position of cornea
vitreous humor: behind lens, gelatin-like substance that supports retina and maintains eye’s shape

4. wait at least 5 mins if more than 1 drug is ordered, this prevents:
to safely give topical ophthalmic agents see ch. 12, also follow these rules:
do not use more than 1 drop (unless otherwise ordered) eye can only hold a small amount of fluid
wait at least 5 mins if more than 1 drug is ordered, this prevents:
2nd drug from washing away 1st
2nd drug from diluting the 1st drug
apply drops before ointments
wait a few hours to apply drops after applying ointment
provide for safety after applying ointments, they may blur vision
know standard colors for ophthalmic labels and bottle caps:
anti-infectives: brown or tan
beta-adrenergic blocking agents: yellow, blue or both
miotics: green
mydriatics and cycloplegics: red (cycloplegics paralyze the ciliary muscle of the eye, used for eye exams)
non-steroidal anti-inflammatory agents: grey

5. Delegation Guidelines Drugs Used to Treat Eye Disorder:
Some drugs used to treat eye disorders are given parenterally- by intramuscular or intravenous injection. Because you do NOT give parenteral dose forms, they are NOT included in this chapter. Should a nurse delegate the administration of such to you, you must:
- remember that parenteral dosages are often very different from dosages other routes
-Refuse the delegation. Make sure to explain why. Do NOT just ignore the request. Make sure the nurse knows that you cannot give drug and why

6. See Box 31-2 (p. 374) Eye disorders
Including glaucoma and cataracts

7. Drug therapy for glaucoma: several drugs are used to treat glaucoma
goals of therapy:
reduce intra-ocular pressure (IOP)
prevent further blindness

8. Assisting With the Nursing Process
Drug therapy for glaucoma:
Osmotic Agents:
cause fluid to be drawn from outside of the vascular system into the blood, this lowers amount of intra-ocular fluid, decreased IOP results
Assisting With the Nursing Process
Osmotic agents:
ASSESSMENT: measure vital signs, weight, intake/output, observe for alertness and orientation to person, time and place
PLANNING: see table 31-1 for “Oral Dose Forms”
IMPLEMENTATION: see table 31-1 for “Adult Dosage”
EVALUATION: report and record:
Thirst: changes in alertness and orientation to person, time and place; confusion; muscle cramps; nausea: may signal dehydration or electrolyte imbalance
Headache: signals cerebral dehydration, person is kept in supine position
Edema and signs/symptoms of heart failure (ch. 21): caused by fluid moving into blood stream

9. Carbonic Anhydrase Inhibitors:
Drug therapy for glaucoma cont….
Carbonic Anhydrase Inhibitors:
agents inhibit carbonic anhydrase, an enzyme
inhibiting the enzyme causes decreased production of aqueous humor, IOP lowers
Assisting With the Nursing Process
Carbonic anhydrase inhibitors:
ASSESSMENT: measure vital signs, weight, intake/output, observe for alertness and orientation to person, time and place, ask about GI signs/symptoms
PLANNING: see table 31-2 for “Oral Dose Forms”
IMPLEMENTATION: see table 31-2 for “Adult Dosage Range”, remove contact lenses for topical dose form, do NOT give drug if person is allergic to sulfonamide antibiotics, give oral dose forms with food/milk to lessen stomach irritation
EVALUATION: report and record:
Thirst: changes in alertness and orientation to person, time and place; confusion; muscle cramps; nausea: may signal dehydration or electrolyte imbalance
Signs and symptoms of allergic reaction to sulfonamide antibiotics: tell nurse at once, do not give next dose unless approved by nurse
Confusion: provide for safety
Drowsiness: usually mild and resolves, provide for safety

10. Assisting With the Nursing Process
Drug therapy for glaucoma cont….
Cholinergic Agents:
produce strong contractions of the iris (miosis)
produce muscle contractions that allow eye to adjust to distances
drugs lower IOP in persons with glaucoma by permitting the out-flow of aqueous humor
they also reverse pupil dilation after eye surgery or eye exams
Assisting With the Nursing Process
ASSESSMENT: measure vital signs
PLANNING: see table 31-3 for “Topical Dose Forms”
IMPLEMENTATION: see table 31-3 for “Adult Dosage”
EVALUATION: report and record:
problems adjusting to changes in light, problems seeing at night, blurred vision: provide for safety
eye irritation, eye redness, headache: usually mild and tend to resolve
pain, discomfort: may occur in bright light
sweating, increased saliva, abdominal discomfort, diarrhea, broncho-spasm, tremors, hypotension, dysrhythmias, bradycardia: signal person is receiving too much of a cholinergic agent

11. echothiophate iodide (Phospholine lodide):
Drug therapy for glaucoma cont….
Cholinesterase Inhibitors:
cholinesterase is an enzyme that destroys acetylcholine
cholinesterase inhibitors prevent the metabolism of acetylcholine within the eye
cholinergic activity increases, which results in decreased IOP and miosis
Assisting With the Nursing Process
echothiophate iodide (Phospholine lodide):
ASSESSMENT: measure vital signs
PLANNING: Topical Dose Form is 0,125% solution
IMPLEMENTATION: 1 drop is instilled 1 or 2 times/day
EVALUATION: report and record:
problems adjusting to changes in light, problems seeing at night, blurred vision: provide for safety
eye irritation, eye redness, headache: usually mild and resolve
sweating, increased saliva, abdominal discomfort, diarrhea, broncho-spasm, tremors, hypotension, dysrhythmias, bradycardia: signal person is receiving too much of a cholinergic agent

12. Adrenergic Agents: used for eye disorders because they cause:
Drug therapy for glaucoma cont….
Adrenergic Agents:
used for eye disorders because they cause:
pupil dilation
increased out-flow of aqueous humor
vaso-constriction
relaxation of the ciliary muscle
a decrease in formation of aqueous humor
goals of therapy:
dilate the pupils (mydriasis) for eye exams
reduce IOP
reduce redness of the eyes from irritation

13. Assisting With the Nursing Process
adrenergic agents:
ASSESSMENT: measure vital signs
PLANNING: see table 31-4 for “Topical Dose Forms”
IMPLEMENTATION: see table 31-4 for “Adult Dosage”
EVALUATION: report and record:
sensitivity to bright light: sunglasses help reduce brightness, provide for safety
eye irritation, tearing: tend to be mild and resolve
palpitations, tachycardia, dysrhythmias, hypertension, faintness, trembling, sweating: signal over-dose or excessive amounts of an adrenergic agent

14. Beta-adrenergic blocking agents:
Drug therapy for glaucoma cont….
Beta-Adrenergic Blocking Agents:
used to reduce elevated IOP
agents are thought to reduce production of aqueous humor
Assisting With the Nursing Process
Beta-adrenergic blocking agents:
ASSESSMENT: measure vital signs
PLANNING: see table 31-5 (p. 380) for “Topical Dose Forms”
IMPLEMENTATION: see table 31-5 for “Initial Adult Dosage”
EVALUATION: report and record:
eye irritation, tearing: tend to be mild and resolve
bradycardia, dysrhythmias, hypotension, faintness, broncho-spasm: dosage may need adjustment

15. prostaglandin agonists:
Drug therapy for glaucoma cont….
Prostaglandin Agonists:
reduce IOP by increasing the out-flow of aqueous humor
used to reduce IOP in persons who have not responded well to other IOP-lowering agents
Assisting With the Nursing Process
prostaglandin agonists:
ASSESSMENT: measure vital signs
PLANNING: see table 31-6 (p. 380) for “Topical Dose Forms”
IMPLEMENTATION: see table 31-6 for “Adult Dosage Range”
EVALUATION: report and record:
eye irritation, burning and stinging, tearing: tend to be mild and resolve
changes in eye color: eye color may gradually change, amount of brown pigment in eye may gradually increase, may take several months or years and is permanent; eyelids may develop color changes. Eyelashes may increase in growth

16. Other ophthalmic Agents:
there are many other drug classes used to treat eye disorders:
anti-cholinergic agents
anti-fungal agents
anti-viral agents
anti-bacterial agents
cortico-steroids
ophthalmic anti-inflammatory agents
antihistamines
anti-allergic agents
artificial tear solutions

17. anti-cholinergic agents:
cause relaxation of certain eye muscles, as a result pupils dilate
this allows:
examination of interior of eye
resting of the eye during uveitis- inflammation of the uveal tract (middle coat of eye)
measurement of lens strength for eyeglasses (refraction)
Assisting With the Nursing Process
anti-cholinergic agents:
ASSESSMENT: measure vital signs
PLANNING: see table for “Topical Dose Forms”
IMPLEMENTATION: see table 31-7 (p. 381) for “Adult Dosage”
EVALUATION: report and record:
sensitivity to bright light (dilated pupils let more light in): sunglasses help reduce brightness, provide for safety
eye irritation, tearing: tend to be mild and resolve
flushing, dry skin, dry mouth, blurred vision, tachycardia, dysrhythmias, urinary hesitancy and retention, vaso-dilation, constipation: signal overdose or excessive administration

18. Assisting With the Nursing Process
Anti-Fungal Agents
used to treat fungal infections in the eye
Assisting With the Nursing Process
natamycin (Natacyn):
ASSESSMENT: ask about eye symptoms, ask about the amount and type of visual impairment
PLANNING: topical dose form is a 5% suspension
IMPLEMENTATION: 1 drop in the eye at 1 or 2 hour intervals for the first 3-4 days. dosage may be reduced to 1 drop every 3-4 hours, therapy is continued days
EVALUATION: report and record:
sensitivity to bright light (dilated pupils let more light in): sunglasses help reduce brightness, provide for safety
blurred vision, tearing, redness: tend to be mild and resolve, provide for safety, remind person not to forcefully rub eyes
eye pain: person needs medical attention
worsening of symptoms: person need medical attention if symptoms worsen or do not improve after several days

19. Anti-Viral Agents trifluridine (Viroptic)
agents inhibit the virus from reproducing
used to treat herpes infections of the eye
Assisting With the Nursing Process
trifluridine (Viroptic)
ASSESSMENT: ask about eye symptoms, ask about the amount and type of visual impairment
PLANNING: topical dose form is a 1% solution in 7.5mL
IMPLEMENTATION: 1 drop onto cornea of affected eye every 2 hours while awake. dosage should NOT exceed 9 drops/day, continue for 7 more days after healing to prevent recurrence- 1 drop every 4 hours (at least 5 drops daily)
EVALUATION: report and record:
visual haze, tearing, redness, burning: usually mild, tend to resolve, provide for safety
sensitivity to bright light (dilated pupils let more light in): sunglasses help reduce brightness, provide for safety
allergic reaction: person needs medical attention

20. Opthalmic antibiotics:
used to treat superficial eye infections
prolonged or frequent use of topical antibiotics should be avoided because of these risks:
hyper-sensitivity reactions
development of resistant organisms, including fungi
see table 38-1
Cortico-Steroids:
used for allergic reactions of the eye
used for acute non-infectious inflammatory conditions of the eye
prolonged therapy may cause glaucoma and cataracts
see table 39-1

21. Ophthalmic Anti-inflammatory Agents:
the following are used before and after cataract surgery:
flurbiprofen (Ocufen): 1 drop in eye every 30mins beginning 2 hours before surgery, a total of 4 drops are given
suprofen (Profenal): 2 drops in eye 3 hours, 2 hours and 1 hour before surgery
diclofenac(Voltaren): 1 drop in eye 4x a day beginning 24 hours after surgery. Drug is continued for 2 weeks
the following is used to relieve eye itching from seasonal allergies:
ketorolac(Acular): 1 drop in each eye 4x a day

22. Anti-Allergic Agents:
Antihistamines:
used to relieve signs/symptoms associated with allergic conjunctivitis
prevent itching
for best results should be instilled before exposure to allergens
see table pg. 384
Anti-Allergic Agents:
inhibit the release of histamine
used to treat allergic eye disorders
cromolyn (Crolom, Opticrom): 1 or 2 drops in each eye 4-6x/day at regular intervals
lodoxamide (Alomide): 1 or 2 drops in each affected eye 4x/day
pemirolast (Almast): 1 or 2 drops in each affected eye 4x/day
nedocromil (Alocril): 1 or 2 drops in each eye 2x/day at regular intervals

23. Artificial Tear Solutions:
they are like natural eye secretions
lubricate dry eyes
may be used as lubricant for artificial eyes
the dosage is 1-3 drops in each eye 3-4x/day as needed
products include:
Isopto Plain
Teargen
Tears Naturale
Murine
Liquifilm Tears