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UPDATE ON DRUGS AND THE EYE

UPDATE ON DRUGS AND THE EYE. LOCAL EFFECTS OF TOPICAL EYE MEDICATION. UPDATE ON DRUGS AND THE EYE. LOCAL EFFECTS OF TOPICAL EYE MEDICATION SYSTEMIC EFFECTS OF TOPICAL MEDICATION. UPDATE ON DRUGS AND THE EYE. LOCAL EFFECTS OF TOPICAL EYE MEDICATION

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UPDATE ON DRUGS AND THE EYE

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  1. UPDATE ON DRUGS AND THE EYE LOCAL EFFECTS OF TOPICAL EYE MEDICATION

  2. UPDATE ON DRUGS AND THE EYE LOCAL EFFECTS OF TOPICAL EYE MEDICATION SYSTEMIC EFFECTS OF TOPICAL MEDICATION

  3. UPDATE ON DRUGS AND THE EYE LOCAL EFFECTS OF TOPICAL EYE MEDICATION SYSTEMIC EFFECTS OF TOPICAL MEDICATION OCULAR EFFECTS OF SYSTEMIC MEDICATION

  4. OCULAR SURFACE TOXICITY • ALL PRESERVATIVES CAN BE DAMAGING

  5. OCULAR SURFACE TOXICITY • ALL PRESERVATIVES CAN BE DAMAGING • BAK IS FOUND IN MOST EYE DROPS AND IS A COMMON CAUSE OF EPITHELIAL TOXICITY ESPECIALLY WHERE MULTIPLE DAILY DROPS ARE REQUIRED ( E.G. GLAUCOMA )

  6. OCULAR SURFACE TOXICITY • ALL PRESERVATIVES CAN BE DAMAGING • BAK IS FOUND IN MOST EYE DROPS AND IS A COMMON CAUSE OF EPITHELIAL TOXICITY ESPECIALLY WHERE MULTIPLE DAILY DROPS ARE REQUIRED ( E.G. GLAUCOMA ) • SOME TOPICAL AGENTS CAN CAUSE PUNCTATE KERATITIS • E.G. TOBRAMYCIN, GENTAMICIN, ACULAR, ACYCLOVIR. EVEN DILATING DROPS CAN CAUSE THIS E.G. PRE-OP PHENYLEPHRINE

  7. OCULAR SURFACE TOXICITY • ALL PRESERVATIVES CAN BE DAMAGING • BAK IS FOUND IN MOST EYE DROPS AND IS A COMMON CAUSE OF EPITHELIAL TOXICITY ESPECIALLY WHERE MULTIPLE DAILY DROPS ARE REQUIRED ( E.G. GLAUCOMA ) • SOME TOPICAL AGENTS CAN CAUSE PUNCTATE KERATITIS • E.G. TOBRAMYCIN, GENTAMICIN, ACULAR, ACYCLOVIR. EVEN DILATING DROPS CAN CAUSE THIS E.G. PRE-OP PHENYLEPHRINE • BEWARE “HIDDEN” PRESERVATIVE E.G. POVIDONE IN REFRESH BLISTER PACKS

  8. LOCAL EFFECTS OF TOPICAL MEDICATION TOXIC EPITHELIOPATHY

  9. LOCAL EFFECTS OF TOPICAL MEDICATION TOXIC EPITHELIOPATHY ALLERGIC CONJUNCTIVITIS

  10. LOCAL EFFECTS OF TOPICAL MEDICATION TOXIC EPITHELIOPATHY ALLERGIC CONJUNCTIVITIS SPECIFIC SIDE EFFECTS

  11. ALLERGIC CONJUNCTIVITIS • ALLERGY TO CHLORAMPHENICOL DROPS AND OINTMENT IS COMMON BUT IT CAN BE SEEN WITH OTHER ANTIBIOTICS SUCH AS SOFRAMYCIN

  12. ALLERGIC CONJUNCTIVITIS • ALLERGY TO CHLORAMPHENICOL DROPS AND OINTMENT IS COMMON BUT IT CAN BE SEEN WITH OTHER ANTIBIOTICS SUCH AS SOFRAMYCIN • I HAVE ALSO SEEN ALLERGY TO AZOPT ON OCCASIONS

  13. ALLERGIC CONJUNCTIVITIS • ALLERGY TO CHLORAMPHENICOL DROPS AND OINTMENT IS COMMON BUT IT CAN BE SEEN WITH OTHER ANTIBIOTICS SUCH AS SOFRAMYCIN • I HAVE ALSO SEEN ALLERGY TO AZOPT ON OCCASIONS • ALPHAGAN ALLERGY IS VERY COMMON AND OFTEN APPEARS AROUND 6 MONTHS • PURITE AS THE PRESERVATIVE ( ALPHAGAN P ) MAY REDUCE THE INCIDENCE AS MAY COMBINING A TOPICAL β BLOCKER • ( E.G. COMBIGAN )

  14. SPECIFIC SIDE EFFECTS OF TOPICAL AGENTS PROSTAGLANDINSCAUSE CONJUNCTIVAL HYPERAEMIA, INCREASED IRIS PIGMENTATION, LASH GROWTH AND INCREASED LOWER LID SKIN PIGMENTATION INCIDENCE XALATAN < TRAVATAN < LUMIGAN

  15. SPECIFIC SIDE EFFECTS OF TOPICAL AGENTS PROSTAGLANDINSCAUSE CONJUNCTIVAL HYPERAEMIA, INCREASED IRIS PIGMENTATION, LASH GROWTH AND INCREASED LOWER LID SKIN PIGMENTATION INCIDENCE XALATAN < TRAVATAN < LUMIGAN PILOCARPINECAUSES CHRONIC PUPILLARY MIOSIS WITH LONG TERM USE

  16. SPECIFIC SIDE EFFECTS OF TOPICAL AGENTS PROSTAGLANDINSCAUSE CONJUNCTIVAL HYPERAEMIA, INCREASED IRIS PIGMENTATION, LASH GROWTH AND INCREASED LOWER LID SKIN PIGMENTATION INCIDENCE XALATAN < TRAVATAN < LUMIGAN PILOCARPINECAUSES CHRONIC PUPILLARY MIOSIS WITH LONG TERM USE TOPICAL STEROIDFOR LONGER THAN 3 WEEKS CAN CAUSE SECONDARY OCULAR HYPERTENSION

  17. SPECIFIC SIDE EFFECTS OF TOPICAL AGENTS PROSTAGLANDINSCAUSE CONJUNCTIVAL HYPERAEMIA, INCREASED IRIS PIGMENTATION, LASH GROWTH AND INCREASED LOWER LID SKIN PIGMENTATION INCIDENCE XALATAN < TRAVATAN < LUMIGAN PILOCARPINECAUSES CHRONIC PUPILLARY MIOSIS WITH LONG TERM USE TOPICAL STEROIDFOR LONGER THAN 3 WEEKS CAN CAUSE SECONDARY OCULAR HYPERTENSION 30% OF THE POPULATION ARE STEROID RESPONDERS

  18. SPECIFIC SIDE EFFECTS OF TOPICAL AGENTS PROSTAGLANDINSCAUSE CONJUNCTIVAL HYPERAEMIA, INCREASED IRIS PIGMENTATION, LASH GROWTH AND INCREASED LOWER LID SKIN PIGMENTATION INCIDENCE XALATAN < TRAVATAN < LUMIGAN PILOCARPINECAUSES CHRONIC PUPILLARY MIOSIS WITH LONG TERM USE TOPICAL STEROIDFOR LONGER THAN 3 WEEKS CAN CAUSE SECONDARY OCULAR HYPERTENSION 30% OF THE POPULATION ARE STEROID RESPONDERS WEAKER STEROIDS SUCH AS FML HAVE LESS OCULAR PENETRATION AND ARE LESS LIKELY TO CAUSE THESE PROBLEMS

  19. SPECIFIC SIDE EFFECTS OF TOPICAL AGENTS PROSTAGLANDINSCAUSE CONJUNCTIVAL HYPERAEMIA, INCREASED IRIS PIGMENTATION, LASH GROWTH AND INCREASED LOWER LID SKIN PIGMENTATION INCIDENCE XALATAN < TRAVATAN < LUMIGAN PILOCARPINECAUSES CHRONIC PUPILLARY MIOSIS WITH LONG TERM USE TOPICAL STEROIDFOR LONGER THAN 3 WEEKS CAN CAUSE SECONDARY OCULAR HYPERTENSION 30% OF THE POPULATION ARE STEROID RESPONDERS WEAKER STEROIDS SUCH AS FML HAVE LESS OCULAR PENETRATION AND ARE LESS LIKELY TO CAUSE THESE PROBLEMS ALPHAGAN CAUSES CONJUNCTIVAL BLANCHING AND PUPIL CONSTRICTION

  20. SPECIFIC SIDE EFFECTS OF TOPICAL AGENTS PROSTAGLANDINSCAUSE CONJUNCTIVAL HYPERAEMIA, INCREASED IRIS PIGMENTATION, LASH GROWTH AND INCREASED LOWER LID SKIN PIGMENTATION INCIDENCE XALATAN < TRAVATAN < LUMIGAN PILOCARPINECAUSES CHRONIC PUPILLARY MIOSIS WITH LONG TERM USE TOPICAL STEROIDFOR LONGER THAN 3 WEEKS CAN CAUSE SECONDARY OCULAR HYPERTENSION 30% OF THE POPULATION ARE STEROID RESPONDERS WEAKER STEROIDS SUCH AS FML HAVE LESS OCULAR PENETRATION AND ARE LESS LIKELY TO CAUSE THESE PROBLEMS ALPHAGAN CAUSES CONJUNCTIVAL BLANCHING AND PUPIL CONSTRICTION IOPIDINE CAUSES CONJUNCTIVAL BLANCHING AND ENLARGED PUPIL

  21. SPECIFIC SIDE EFFECTS OF INTRAVITREAL DRUGS AVASTIN/LUCENTIS ARE ASSOCIATED WITH POSSIBLE INCREASED RISK OF CARDIOVASCULAR ADVERSE EFFECTS MAINLY STROKE AND MYOCARDIAL INFARCTION

  22. SYSTEMIC EFFECTS OF TOPICAL MEDICATION • β BLOCKERS CAN CAUSE ASTHMA AND BRADY CARDIA

  23. SYSTEMIC EFFECTS OF TOPICAL MEDICATION • β BLOCKERS CAN CAUSE ASTHMA AND BRADY CARDIA • α BLOCKERS MAY LOWER B P

  24. SYSTEMIC EFFECTS OF TOPICAL MEDICATION • β BLOCKERS CAN CAUSE ASTHMA AND BRADY CARDIA • α BLOCKERS MAY LOWER B P • CHLORAMPHENICOL – VERY RARE ASSOCIATION WITH APLASTIC ANAEMIA

  25. SYSTEMIC EFFECTS OF TOPICAL MEDICATION • β BLOCKERS CAN CAUSE ASTHMA AND BRADY CARDIA • α BLOCKERS MAY LOWER B P • CHLORAMPHENICOL – VERY RARE ASSOCIATION WITH APLASTIC ANAEMIA • PHENYLEPHRINE 10% MAY CAUSE TACHYCARDIA ± SYSTEMIC HYPERTENSION ( ESPECIALLY IN ELDERLY )

  26. SYSTEMIC EFFECTS OF TOPICAL MEDICATION • β BLOCKERS CAN CAUSE ASTHMA AND BRADY CARDIA • α BLOCKERS MAY LOWER B P • CHLORAMPHENICOL – VERY RARE ASSOCIATION WITH APLASTIC ANAEMIA • PHENYLEPHRINE 10% MAY CAUSE TACHYCARDIA ± SYSTEMIC HYPERTENSION ( ESPECIALLY IN ELDERLY ) • CYCOGYL DROPS CAN BE ASSOCIATED WITH DROWSINESS AND RARELY WITH AGITATION

  27. SYSTEMIC EFFECTS OF TOPICAL MEDICATION • β BLOCKERS CAN CAUSE ASTHMA AND BRADY CARDIA • α BLOCKERS MAY LOWER B P • CHLORAMPHENICOL – VERY RARE ASSOCIATION WITH APLASTIC ANAEMIA • PHENYLEPHRINE 10% MAY CAUSE TACHYCARDIA ± SYSTEMIC HYPERTENSION ( ESPECIALLY IN ELDERLY ) • CYCOGYL DROPS CAN BE ASSOCIATED WITH DROWSINESS AND RARELY WITH AGITATION • ATROPINE DROPS MAY ALSO CAUSE SYSTEMIC SIDE EFFECTS ESPECIALLY IN YOUNG CHILDREN

  28. LOCAL OCULAR EFFECTS OF SYSTEMIC DRUGS • PLAQUENIL: • AVIDLY BOUND TO RPE AND CAN CAUSE MACULAR TOXICITY

  29. LOCAL OCULAR EFFECTS OF SYSTEMIC DRUGS • PLAQUENIL: • AVIDLY BOUND TO RPE AND CAN CAUSE MACULAR TOXICITY • PREDNISONE: • CAN BE ASSOCIATED WITH PSCC AND NUCLEAR SCLEROTIC CATARACT

  30. LOCAL OCULAR EFFECTS OF SYSTEMIC DRUGS • PLAQUENIL: • AVIDLY BOUND TO RPE AND CAN CAUSE MACULAR TOXICITY • PREDNISONE: • CAN BE ASSOCIATED WITH PSCC AND NUCLEAR SCLEROTIC CATARACT • FLOMAXTRA: • DIFFICULT CATARACT SURGERY • LOSS OF IRIS TONE • POOR PUPIL DILATATION • PROGRESSIVE MIOSIS DURING OP

  31. LOCAL OCULAR EFFECTS OF SYSTEMIC DRUGS • PLAQUENIL: • AVIDLY BOUND TO RPE AND CAN CAUSE MACULAR TOXICITY • PREDNISONE: • CAN BE ASSOCIATED WITH PSCC AND NUCLEAR SCLEROTIC CATARACT • FLOMAXTRA: • DIFFICULT CATARACT SURGERY • LOSS OF IRIS TONE • POOR PUPIL DILATATION • PROGRESSIVE MIOSIS DURING OP • ANTICHOLINERGICS E.G. TRYPTANOL ANTI SPASMODICS: • CAN PRECIPITATE AACG IN PREDISPOSED INDIVIDUALS • CONFUSES DOCTORS AS THE TYPE OF GLAUCOMA IS NOT SPECIFIED IN PRODUCT INFORMATION

  32. LOCAL OCULAR EFFECTS OF SYSTEMIC DRUGS • PLAQUENIL: • AVIDLY BOUND TO RPE AND CAN CAUSE MACULAR TOXICITY • PREDNISONE: • CAN BE ASSOCIATED WITH PSCC AND NUCLEAR SCLEROTIC CATARACT • FLOMAXTRA: • DIFFICULT CATARACT SURGERY • LOSS OF IRIS TONE • POOR PUPIL DILATATION • PROGRESSIVE MIOSIS DURING OP • ANTICHOLINERGICS E.G. TRYPTANOL ANTI SPASMODICS: • CAN PRECIPITATE AACG IN PREDISPOSED INDIVIDUALS • CONFUSES DOCTORS AS THE TYPE OF GLAUCOMA IS NOT SPECIFIED IN PRODUCT INFORMATION • DIAMOX: • RARE ASSOCIATION WITH ACUTE GLAUCOMA • LOW SERUM K⁺ / BLOOD DISORDERS

  33. LOCAL OCULAR EFFECTS OF SYSTEMIC DRUGS • PLAQUENIL: • AVIDLY BOUND TO RPE AND CAN CAUSE MACULAR TOXICITY • PREDNISONE: • CAN BE ASSOCIATED WITH PSCC AND NUCLEAR SCLEROTIC CATARACT • FLOMAXTRA: • DIFFICULT CATARACT SURGERY • LOSS OF IRIS TONE • POOR PUPIL DILATATION • PROGRESSIVE MIOSIS DURING OP • ANTICHOLINERGICS E.G. TRYPTANOL ANTI SPASMODICS: • CAN PRECIPITATE AACG IN PREDISPOSED INDIVIDUALS • CONFUSES DOCTORS AS THE TYPE OF GLAUCOMA IS NOT SPECIFIED IN PRODUCT INFORMATION • DIAMOX: • RARE ASSOCIATION WITH ACUTE GLAUCOMA • LOW SERUM K⁺ / BLOOD DISORDERS • GLIVEC: • CME AND LID OEDEMA

  34. PLAQUENIL TOXICITY THIS DRUG IS FAIRLY SAFE HIGHER RISK SEEN IN THE FOLLOWING:

  35. PLAQUENIL TOXICITY THIS DRUG IS FAIRLY SAFE HIGHER RISK SEEN IN THE FOLLOWING: DOSE > 6.5mg/Kg OF IDEAL BODY WEIGHT

  36. PLAQUENIL TOXICITY THIS DRUG IS FAIRLY SAFE HIGHER RISK SEEN IN THE FOLLOWING: DOSE > 6.5mg/Kg OF IDEAL BODY WEIGHT DURATION OF TREATMENT > 10 YEARS

  37. PLAQUENIL TOXICITY THIS DRUG IS FAIRLY SAFE HIGHER RISK SEEN IN THE FOLLOWING: DOSE > 6.5mg/Kg OF IDEAL BODY WEIGHT DURATION OF TREATMENT > 10 YEARS LIVER OR KIDNEY DISEASE ( REDUCED DRUG EXCRETION )

  38. PLAQUENIL TOXICITY THIS DRUG IS FAIRLY SAFE HIGHER RISK SEEN IN THE FOLLOWING: DOSE > 6.5mg/Kg OF IDEAL BODY WEIGHT DURATION OF TREATMENT > 10 YEARS LIVER OR KIDNEY DISEASE ( REDUCED DRUG EXCRETION ) ? COINCIDENT MACULAR DISEASE E.G. DRUSEN

  39. MONITORING PLAQUENIL DISTANCE AND NEAR V A

  40. MONITORING PLAQUENIL DISTANCE AND NEAR V A COLOUR VISION ( B/Y PLATES )

  41. MONITORING PLAQUENIL DISTANCE AND NEAR V A COLOUR VISION ( B/Y PLATES ) AMSLER

  42. MONITORING PLAQUENIL DISTANCE AND NEAR V A COLOUR VISION ( B/Y PLATES ) AMSLER ? BLUE ON YELLOW FIELDS

  43. MONITORING PLAQUENIL DISTANCE AND NEAR V A COLOUR VISION ( B/Y PLATES ) AMSLER ? BLUE ON YELLOW FIELDS ERG/EOG IF > 5 YEARS CONTINUOUS TREATMENT

  44. Which of the following ocular side effects is not associated with Flomaxtra? • A. Poor pupil dilatation • B. Iris flaccidity during cataract surgery • C. Progressive miosis during cataract surgery D. Ocular hypertension

  45. Which of the following eye drop preservatives is most likely to cause corneal epithelial toxicity? • A. Purite • B. Polyquaternium • C. Benzalkonium Chloride D. Povidone

  46. Which of the following is not a side effect of topical or systemicB Blockers? • A. Brady cardia ( slow pulse ) • B. Asthma • C. BP lowering D. High BP

  47. Which of the following is not a known side effect of topical prostaglandins? • A. Conjunctival hyperaemia • B. Lash growth • C. Lid pigmentation D. Pupillary constriction

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