Commonly used eye drops

2021-02-02 12:00 AM

Disinfectants are nonspecific antibacterial agents with a wide spectrum of action and less local toxicity. In the past, antiseptics were used very widely to treat inflammatory diseases of the eyelids and cornea.

 

Commonly used eye drops diagnosisbook

Local anaesthetic

Anaesthetic eye drops are very popular in ophthalmology. In the process of eye examination and treatment, many procedures need to use an anaesthetic such as glaucoma, pre-room angioplasty, some minor surgeries (eyewash, foreign body removal, practice ...) and most eye surgery. Some commonly used eye sedatives are:

Cocaine 2 - 4%: This drug is highly toxic and causes many side effects (dilated pupils, regulatory paralysis, corneal oedema, changes in eye pressure, etc.), so it is less common.

Proparacaine 0.5% (Alcain, Ophthain, Opthetic): This drug is the least irritating and has almost no side effects. It works after 15 seconds and lasts 20 minutes.

Tetracaine 0.5% (Ponto Caine, Amethocaine, Decamine): This drug is more potent and lasts longer than proparacaine, but is more toxic, may cause eye irritation and corneal oedema or corneal epithelial exfoliation.

Due to the above risks, do not overuse anaesthetic eye drops and use them only in a hospital.

Insecticide

Disinfectants are nonspecific antibacterial agents with a wide spectrum of action and less local toxicity. In the past, antiseptics were used very widely to treat inflammatory diseases of the eyelids and cornea. Eye antiseptics may be combined with a vasoconstrictor. Commonly used topical antiseptics are metal salts:

Mercury salt (thimerosal liquid medicine).

Silver nitrate (liquid medicine) is used to treat eye inflammation in babies.

Gold mercury oxide (ointment).

Sulfates (zinc, copper).

Currently, silver salt and mercury salt disinfectants are less commonly used because they can be toxic to the tear film, especially in people with dry eyes.

Some other antiseptics such as tonsils (Vitabact), colourants (methylene blue), 4th-grade ammonium (benzalkonium).

Antibiotics

Antibiotic ophthalmic (liquid or ointment) is widely used today and is the main tool for treating infections of the anterior part of the eyeball such as conjunctivitis, corneal ulcer, inflammation of the eyelashes, etc. The disadvantages of ophthalmic antibiotics are that they are universally selective, cause allergies, and can facilitate the emergence of resistant strains. To increase the effectiveness of treatment, it is necessary to combine an antibiotic with an antibiotic or an antiseptic. The groups of ophthalmic antibiotics include:

Beta-lactam group (penicillin and cephalosporin): are effective antibiotics for eye infections. Bacterial resistance to penicillinase and beta-lactamase requires the selection of penicillin as well as appropriate generations of cephalosporins. This group easily causes allergic reactions, sometimes very dangerous, so it should be used with caution, especially for children.

Chloramphenicol (chloride): has the advantage of being broad-spectrum (good effect against both gram-positive and gram-negative bacteria), good precaution penetration, and less allergenic, therefore it is used very popularly. Chloramphenicol can cause bone marrow failure, so be careful not to use it in children.

Aminoglycoside group: 1st generation drugs (neomycin, kanamycin, framycetin) are often used for prophylaxis. Second-generation drugs (gentamycin, neomycin): are hypoallergenic and have a broad spectrum of effects, except for streptococcus, pneumococcal, and meningococcal brain.

Cyclin group (aureomycin, Terramycin, tetracycline): less stable in solution, so it is often used in the form of ointment. This group works well with cocci, used to treat trachoma or preventive treatment for neonatal eye infections. The downside of the drug is its inability to penetrate the room.

The fluoroquinolone group (norfloxacin, ofloxacin, ciprofloxacin, etc.) are broad-spectrum antibiotics, which inhibit most bacteria and are less toxic to the corneal epithelium than aminoglycoside.

Polypeptide group: which is often used in the form of eye drops with polymyxin and bacitracin. Polymyxin B is used very well to treat corneal ulcers, the drug works well with gram-negative bacteria including Enterobacter, Klebsiella, and especially with P. aeruginosa (green pus bacilli). Bacitracin works well with Neisseria, H influenzae, Actinomyces and most gram-negative bacteria.

Antifungal medicine

Antifungal drugs can be divided into 2 categories: antibiotic antifungal and non-antibiotic antifungal. Currently, there are not many antifungal drugs in the form of eye drops.

Amphotericin B (Fungizone): is an antifungal agent. The drug has a wide spectrum, works with many fungi, especially Histoplasma, Blastomyces, Cryptococcus, and some strains of Candida, so it is used in the treatment of fungal corneal ulcers.

Natamycin (Natacyn, Pimaricin): is an antifungal medication in the form of a 0.5% eye patch solution. This drug works well with mycelium and yeasts, including Candida, Aspergillus, Cephalosporium, Fusarium, Penicillium. Indications of the drug are fungal diseases of the conjunctiva, cornea, blebs. Medications that can cause an allergic conjunctivitis side effect are one of the side effects.

Miconazole (Monistat): effects with Candida, Cryptococcus, Aspergillus. It can be used as eye drops or injected under the conjunctiva to treat corneal fungal infections. Local side effects can be itching, burning, and irritation.

Antiviral medication

Most antivirals act by inhibiting viral DNA synthesis by inhibiting DNA synthesis or by producing abnormal DNA. Since the synthesis of viral DNA is completely dependent on host cell metabolism and the drug does not have a specific enzyme system of the virus that is affected by the drug, the growth of normal cells is also May be affected by medication. Available antivirals include:

Idoxuridine (IDU, Herplex): IDU (0.1% liquid or 0.5% ointment) is used to treat keratitis caused by herpes simplex virus and vaccinia. Best works with inflammatory forms that damage the epithelium. Possible side effects: mild irritation of the eyelashes and conjunctiva, corneal oedema, damage to the corneal epithelium, 

Vidarabine (Vira-A) 3% ointment: indications of the drug are the same as IDU, often used for cases of treatment of IDU, not results or keratitis caused by recurrent herpes simplex. Some possible side effects include mild irritation, watery eyes, foreign body feeling, conjunctival erection, burning eyes.

Trifluridine (Virotic) 1% solution: better solubility than the two drugs above, so it penetrates the cornea better, so it can be used for viral iritis. The drug can cause conjunctival erection or damage to the corneal epithelium.

Acyclovir (Zovirax) 3% ointment: drugs with selective effects on herpes viruses including herpes simplex, herpes zoster (shingles), cytomegalovirus, and EB virus, less toxic to normal cells.

Anti-inflammatory drugs

Steroidal anti-inflammatory drugs and nonsteroidal anti-inflammatory drugs are widely used to reduce the inflammatory processes of the eye. In addition to reducing inflammation, some drugs also have anti-allergic, anti-cystic macular oedema, and prevent pupil contraction during surgery.

Steroid anti-inflammatory drugs

The steroidal anti-inflammatory drugs (corticosteroids) act on both non-specific and non-specific immune mechanisms, so it is very effective against inflammatory and allergic processes in the eye. Corticosteroids play a decisive role in the treatment of many inflammatory diseases of the anterior part of the eyeball such as allergic conjunctivitis, spring conjunctivitis, scleritis or adrenalitis, uveitis, blister conjunctivitis, shallow dot keratitis, deep keratitis.

Corticosteroids can also cause eye side effects, including:

Slows the healing of corneal scarring, thereby aggravating corneal ulcers caused by bacteria, fungi.

Facilitates the emergence of fungal and viral diseases in the eye (especially herpes corneal ulcers).

Causes glaucoma (especially soluble corticosteroids).

If used for a long time, corticosteroids can also cause some other side effects such as cataracts (especially posterior cataracts), corneal purulent, dilated pupils, droopy eyelashes.

Therefore, only when indicated, corticosteroids should be used in combination with an antibiotic, closely monitoring the eye pressure and vitreous if the drug is used for a long time.

Ocular corticosteroids can be in the form of a dissolved solution, suspension, or ointment. The anti-inflammatory effects of drugs are very different, can be divided into 3 levels: weak effects (cortisol and hydro cortisol), moderate effects (prednisolone, prednisolone), strong effects (dexamethasone, betamethasone). Some of the most popular drugs today are:

Simple corticosteroids: Dexamethasone (Maxidex), Fluorometholon (Flarex), Prednisolone (Pred Forte).

Corticosteroids combined with another antibiotic: Dexamethasone + Oxytetracycline (Sterdex), Dexamethasone + Framycetin (Frakidex), Betamethasone + Gentamycin (Gentasone), Dexamethasone + Tobramycin (Tobradex), Dexamethasone + Chloramphenamethasol (Cebedex) Maxidrol).

Nonsteroidal anti-inflammatory drugs

Nonsteroidal anti-inflammatory drugs (often abbreviated as NSAIDs) inhibit the enzyme cyclo-oxygenase (involved in the synthesis of prostaglandins (mediators for inflammatory processes), thereby reducing inflammation. Based on the chemical structure of the drug, it is classified into 4 groups: salicylate, indole, phenylancanoic acid, pyrazolone Some of the most popular nonsteroidal anti-inflammatory drugs today are:

Indomethacin (Indocollyre): reduces inflammation and anti-cystic macular oedema in the eye after vitreous surgery.

Flurbiprofen (Ocufen): anti-inflammatory, anti-shrinkage effect by inhibiting prostaglandin, therefore used in vitreous surgery.

Diclofenac (Voltaren): used to fight inflammation after surgery, in addition to work to treat cystic macular oedema.

The drug reduces the incidence, vasoconstriction and anti-allergic

Allergic inflammatory reactions in the eye triggered by antigen binding to antibodies on the surface of mast cells and basophils cause secretory particles to release chemical mediators such as histamine, prostaglandins., leukotriene etc. led to vasodilator phenomena and increased permeability (manifested by itching, erection and oedema of the tissue).

Some ophthalmic agents such as Lod oxamide (Aklomide) or Cromolyn sodium (Crolom) stabilize the membranes of mast cells, thereby preventing the release of chemical mediators. These drugs are indicated in cases of eye allergies such as spring conjunctivitis, allergic conjunctivitis.

Mild allergic cases can be treated with drugs containing an antihistamine (often using antazoline or pheniramine) with a vasoconstrictor (usually naphazoline or phenylephrine). For example: Vazocon-A (naphazoline + antazoline), Naphcon-A (naphazoline + pheniramine).

The drug dilates the pupils and paralysis of the eyelids

Dilated pupils can be done in two ways: paralyzing the sphincter of the iris (parasympathetic drugs) or stimulating the iris relaxant muscles (sympathomimetic drugs). If the combination of both drugs can maximize pupil dilatation. Medicines that paralyze the parasympathetic, in addition to dilating the pupil, also have the effect of causing ciliary paralysis, thus causing paralysis. Non-regulatory dilated pupils are often used for fundoscopy or to dilate the pupils before cataract surgery. Regulatory pupil dilators are often used for pediatric refractometry, diagnosing ataxia, anti-iris stickiness and pain relief in uveitis. Caution should be exercised when using pupil dilators in the eye with a narrow anterior chamber because it can cause an attack of glaucoma. Some commonly used pupil relaxants and regulators are listed in the table.

Board. Some pupil relaxants and regulatory paralysis

 

Drug name
 

Duration of effect (minutes)

Duration of effect

 

Side effects

 

Note

Phenylephrine
(Neo-synephrine 2,5%, 10%)

20

23 hours

May cause chest pain, hypertension, myocardial infarction (mainly 10% solution)

Do not paralyze regulation

Tropicamide
(Mediacy 0,5%, 1%)
 

25

4 -6 hours

Trivial

Good pupil dilatation and mild regulatory paralysis

Cyclopentolate
(Cyclogyl 0,5%, 1%, 2%)

30

12 - 24 hours

Neurotoxicity, hallucinations, convulsions, slurred speech, convulsions

Common side effects in children

Homatropine 1%, 2%, 5%

40

2-3 days

Neurological disturbances, dizziness

 

Atropine 0.25%, 0.5%, 1%

30

1-2 weeks

Redness, fever, tachycardia, agitation, agitation

Low concentrations for young children

Drugs for treatment of glaucoma

There are many types of eye drops used in the treatment of glaucoma. In closed-angle glaucoma, treatment is mainly surgical, usually only to lower eye pressure before surgery or to add additional treatment in some cases after surgery. In open-angle glaucoma, long-term treatment with eye drops is possible. Glaucoma medications work by increasing aqueous discharge or reducing aqueous production. Depending on the mechanism of action, these drugs are classified into 5 groups:

Medicines like sympathomimetics

The mechanism of action of parasympathetic analogues is to enlarge the raft area to enhance fluid circulation and lower intraocular pressure. Some of the drugs in this group are:

Pilocarpine (0.5 - 10% solution, 4% ointment), and granular put together (Ocusert): is a very popular treatment for glaucoma.

Carbachol (0.75%, 1.5%, 2.25% and 3% solution): very poorly absorbed through the cornea.

Side effects of these drugs are pupil shrinkage (may affect vision, especially those with cataracts) and ciliary cramping (leading to pain in the eyebrow arch and refractive changes of the eye, i.e., nearsighted).

Sympathomimetics

These drugs work to reduce the production of aqueous humour and expand the raft area, thereby lowering the eye pressure. Some of the drugs in this group are:

Epinephrin (Ephrin, Glaucon) 0,25%, 0,5%, 1%, và 2%.

Dipivefrin (relatives) 1%.

Apraclonidine (Iopidine) 0,5%.

Local side effects include eye redness due to vascular accumulation and cystic macular oedema in people who no longer have vitreous lenses. Systemic side effects include tachycardia, high blood pressure, tremor, and anxiety.

Beta-blockers

Beta-blockers act on beta1 (affecting the heart) and beta2 (affecting the lungs) receptors. The mechanism of hypotension is the inhibition of aqueous production by the ciliary epithelial cells. Beta-blockers are divided into 2 types:

Non-selective beta blockers: timoptic (Timolol) 0.25% and levobunolol (Betagan) 0.5%.

Selective beta blocker (only works on beta1 receptors): betaxolol (Betoptic) 0.5%.

Beta-blockers can cause a number of systemic side effects such as tachycardia, increased heart flow, bronchospasm, increased blood pressure, syncope, and depression. Selective beta-blockers cause less bronchospasm, so they are safer for people with lung disease. 

Carbonic anhydrase inhibitors

Carbonic anhydrase is involved in the aqueous production of the ciliary epithelial cells. Carbonic anhydrase inhibitors will reduce aqueous production and lower intraocular pressure. Oral acetazolamide (Diamox) has the disadvantages of causing many systemic side effects (nausea, ringing in the ears, feeling of needles in the fingers, loss of appetite, hypokalemia, kidney stones, etc.). Currently, there are 2 types of eye drops are dorzolamide (Trusopt) or brinzolamide (Azopt).

Drug analogue of prostaglandin

This is a new class of drugs used to treat glaucoma. The advantage of these drugs is that they only need to be taken once a day and are safe for people with heart and lung disease. The mechanism of hypotension is to increase the circulation of aqueous humour through the uveum-sclera route (20% of the aqueous fluid circulates through this path). This drug can be used in combination with another drug group. Some of the possible side effects in this class of drugs are irritation, conjunctival erection, iritis hyperpigmentation, or cystic macular oedema. Currently, there are two popular drugs: travoprost (Travatan) and latanoprost (Xalatan).

Artificial tears

Medicines used to smooth the conjunctival surface and replace tears are used to treat dry eyes or some corneal diseases. The basic ingredients of artificial tears are a buffer solution, surfactant, and mucus (methylcellulose or ethylcellulose) to increase corneal contact time. Artificial tears can come in the form of liquid medicine or ointment. Some common examples of artificial tears are Tears Naturale II, Sanlein, PolyTears, Tears Plus, Refresh. Now available artificial tears without preservatives, such as Refresh Plus or Celluvisc, are not toxic to the corneal epithelium.

Medicines help corneal scar healing

The eye drops used to promote the recovery of damage to the cornea are mainly vitamins, nandrolone, acetylcysteine, nucleosides. These drugs work by two mechanisms: enhancing corneal epithelial regeneration or counteracting collagenase enzymes. The indication of the drug is for corneal lesions such as corneal ulcers or corneal nutritional disorders. Some common drugs are Vitamin A, Vitamin B12, Vitacic, Kératyl, Amici, Ophtasiloxane.

Dyes used for diagnosis

There are two very popular drugs (liquid or paper bandages):

Fluorescein (0.5-2% solution) is an orange-yellow drug that emits a greens-green colour against a cobalt blue light. This drug is used to detect corneal epithelial lesions such as superficial keratitis, corneal scratch, and corneal ulcer. Fluorescein is also used to measure eye pressure with a Goldman manometer.

Pink Bengal (1% solution) is a red drug that stains necrotic epithelial cells. This drug is mainly used in the diagnosis of dry eye.

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