General information

about eyes
The part of eye Function
eyelids They offer protection from excessive light or injury, and maintain
lubrication by distributing tears over the surface of the eyeball.
Optic nerve Relay messages from your eyes to your brain to create visual images. They
play a crucial role in your ability to see. Millions of nerve fibers make up
each optic nerve. Damage to an optic nerve can lead to vision loss in one or
both eyes.
Conjunctiva The conjunctiva keeps your eye lubricated and prevents irritants from
getting in. It works with a few glands to create your tears and protects the
white part of your eyes from damage. Common conditions like pink eye
(conjunctivitis) and sub conjunctiva hemorrhages are usually minor issues
that require very little treatment.
ciliary muscle muscles that control the movements of the lens and pupil and thus
participate in the accommodation of vision
Pupils Allow light to enter the eye. By changing its size, the pupil can adjust the
quantity of light entering the eye. When there is very low light, the pupil
dilates (increases in size) to allow sufficient light to reach the retina (this is
what enables night vision). When there is too much light, the pupil
contracts (reduces in size) to restrict the amount of light entering the eye;
this contraction helps prevent glare or damage to the sensitive lens and
retina.
Most common eye
problems
 Administration of drugs to
the eye

1-When two different eye preparations are used at the same time of day, the patient
should leave an interval of at least 5 minutes between the two, to allow the first to be fully
absorbed; eye ointment should be applied after drops.
‫ر‬
‫زمن ال‬ ‫ر ر‬ ‫ر‬ ‫ر‬
‫ يجب عىل المريض ترك فاصل ي‬، ‫عند استخدام مستحضين مختلفي للعي يف نفس الوقت من اليوم‬
‫ر‬
. ‫العي بعد قطرات‬ ‫ر‬
‫ للسماح بامتصاص األول بالكامل ؛ يجب تطبيق مرهم‬، ‫االثني‬ ‫ دقائق ر‬5 ‫يقل عن‬
‫بي‬

1st
5 minutes

2nd

2-Eye drops and ointments may cause temporary blurring of vision. If affected, patients
should be warned not to drive or perform other skilled tasks until vision is clear.
‫ر‬
‫المرض من القيادة أو‬ ‫ يجب تحذير‬، ‫ ر يف حالة التأثر‬.‫العي والمراهم ضبابية مؤقتة ر يف الرؤية‬
‫ر‬ ‫قد تسبب قطرات‬
‫ى‬
.‫أداء مهام ماهرة أخرى حن تصبح الرؤية واضحة‬

3-Eye preparations in multiple-application containers for use by the patient at home are
normally discarded 4 weeks after first opening (unless otherwise stated by the
manufacturer).

4-Systemic effects may arise from absorption of drugs into the general circulation either
directly from the conjunctival sac or after the excess
preparation has drained down through the tear ducts into the
nasal cavity. Nasal drainage of drugs is associated with eye
drops much more often than with eye ointments. Applying
pressure on the lacrimal punctum for at least a minute after
administering eye drops reduces nasolacrimal drainage and
therefore decreases systemic absorption from the nasal
mucosa.
5-Very important: If using a suspension, shake well before instilling. If using the suspension
with another dosage form, place the suspension drop last, because it has prolonged
retention time in the tear film.

Note: most steroid eye drops present as a suspension.

6-Important: If both drop and ointment therapy are indicated, instill the drops at least 10
minutes before the ointment so that the ointment does not become a barrier to the drops'
penetrating the tear film or cornea.

Contact lenses and drug treatment

1-Unless medically indicated, soft lenses should be

removed before instillation of the eye
preparation. Alternatively, unpreserved drops can
be used, as preservatives accumulate in soft lenses
and can cause irritation.

Patients who wear soft contact lenses should be

advised to stop wearing them while treatment
continues and for 48 hours afterwards. This is
because preservatives in the eye drops can damage lenses.

2-Eye drops, however, may be instilled while patients are wearing hard contact lenses but
removal prior to instillation is still generally advised

3-Ointment preparations should never be used in conjunction with contact lens wear; oily
eye drops can cause lens deposits and should also be avoided. Many drugs given
systemically can also have adverse effects on contact lens wear.
 Antibacterial eye preparations

Pathogens that cause bacterial conjunctivitis vary between adults and children. In adults,
Staphylococcus species are most common (>50% of cases), followed by Streptococcus
pneumoniae (20%), Moraxella species (5%) and Haemophilus influenzae (5%). In children,
Streptococcus, Moraxella and Haemophilus are most common. The adenovirus is most
commonly implicated in viral conjunctivitis, and pollen usually causes seasonal allergic
conjunctivitis.
1-Most acute superficial eye infections can be treated topically with eye drops or ointment.
Systemic administration is sometimes appropriate in blepharitis.

2-Common antibacterial available as an eye preparations include:

A-Aminoglycosides: gentamicin, neomycin, and tobramycin.
B-Cephalosporins (second-generation): cefuroxime (intra-ocular injection injection).
C-Macrolides: azithromycin.
D-Quinolones: ciprofloxacin, levofloxacin, moxifloxacin, and ofloxacin.
E-Others: chloramphenicol, fusidic acid and polymyxin B.
Scientific name Trade name Dosage form
1 Fusidic acid Fusithalmic Eye drop , ointment
2 Gentamicin Genedin Eye drop , ointment
3 Tobramicin Tobravisc Eye drop
4 Tetracycline Sumycin or Tetra. Eye ointment
Ciprofloxacin Ciloxan
5 Eye drop
Oflaxacin Oflex
6 Choramphenicol Chloromycetin Eye drop , ointment
 Antivirals and antifungals

1-Commonly used antivirals are aciclovir (acyclovir) or ganciclovir for herpes simplex
infections.
2-Fungal infections of the cornea are rare. Antifungal preparations for the eye are not
generally available. Treatment will normally be carried out at specialist centers.

Corticosteroids and other anti-inflammatory

preparations
redness ‫ وتقلل من‬inflammation ‫ تقلل من‬anti-inflammatory ‫ هي‬Corticosteroids ‫ال‬
surgery of eyes ‫ و توصف بعد العمليات الجراحية‬injury ‫وتوصف من يصير‬
1-Commonly used corticosteroids are: betamethasone, dexamethasone,
fluorometholone, hydrocortisone, and prednisolone.

2-They are used to treat inflammatory eye conditions. Topical

corticosteroids are applied frequently for the first 24–48 hours; once
inflammation is controlled, the frequency of application is reduced.
3-Combination products containing a corticosteroid with an anti-infective drug are sometimes used
after ocular surgery to reduce inflammation and prevent infection; use of combination products is
otherwise rarely justified.

4-An intravitreal implant containing dexamethasone or fluocinolone are also

available for certain eye conditions.

5-Steroid glaucoma’ can follow the use of corticosteroid eye preparations in

susceptible individuals; a ‗steroid cataract’ can follow prolonged use.

6-Other anti-inflammatory preparations used for the topical treatment of inflammation

and allergic conjunctivitis include sodium cromoglicate (sodium cromoglycate), and
nedocromil sodium. Lodoxamide eye drops are used for allergic conjunctival conditions
including seasonal allergic conjunctivitis.

7-NSAIDs:
A-NSAIDs eye drops such as bromfenac, diclofenac( ‫(قطرات اللحيم‬, flurbiprofen, and
ketorolac are used for the prophylaxis and treatment of inflammation, pain, and other
symptoms associated with ocular surgery or laser treatment of the eye. ( ‫(قطرات اللحيم‬
B-Diclofenac sodium and flurbiprofen are also used to prevent miosis during ocular surgery.
C-Diclofenac eye drops may be used for seasonal allergic conjunctivitis.
D-Contra-indicated in patients with a history of hypersensitivity to aspirin or any other
NSAID.
8-Eye drops containing antihistamines, such as antazoline, azelastine, epinastine,

Antibacterials with corticosteroids

Betamethasone 0.1% Methadin-N® Eye drop
Neomycin sulfate 0.5%
Dexamethasone 0.1% Tobradex®| Eye drop
tobramycin 0.3%
Polymyxin B. Neomycin and PND® Eye drop
Dexamethasone.

Neomycin , polymyxin Maxitrol® Eye drop

B, Dexamethasone

corticosteroids
Prednisolone acetate Pred-mild® Eye drop
0.12% , And
1% Pred-forte®
Fluorometholone FML® Eye drop
Betamethasone 0.1% Methadin® Eye drop
Olopatadine Opatanol® Eye drop
Ketotifen fumarate Zalidin ® Eye drop
Fluriprpfen Flurptic ® Eye drop

Other anti-inflammatory preparations

1 Diclofenac Valtarene Eye drop
Diclogesic
2 Sodium cromoglicate Allergotin or Crom Eye drop
 Decongestants and decongestants-
antihistamine combination
1-Such preparation may be intended for the treatment of allergic conjunctivitis.

2-These agents can be used to reduce redness of the eye. Products contain a combination
of sympathomimetic and antihistamine or sympathomimetic alone.

They are useful in reducing redness in the eye but will not treat the underlying pathology
that is causing the eye to be red. They should be limited to short-term use to avoid
rebound effects.

3-Common decongestants-antihistamine combination is (naphazoline-antazoline).

Scientific name Trade name Dosage form
1 Naphazoline Ophthazolin Eye drop
Antazoline
2 Oxymetazoline Nasordin Nasal & eye drop
3 Naphazoline Naphicon Eye drop
 Drugs for dry eye (tear
deficiency) (artificial tears).

1-Hypromellose is the most frequently used treatment for tear deficiency in patients with
mild dry eye. Initially, it may need to be instilled frequently (e.g. hourly) for adequate
symptom relief, then at a reduced frequency. Carbomers and polyvinyl alcohol are
suitable alternatives.

2-The ability of carbomers and polyvinyl alcohol to cling to the eye surface and their
higher viscosity may help reduce frequency of application to 4 times daily.

3-Preservative-free tear replacement is preferred in cases of frequent and chronic

application.

The preservative that most often causes eye irritation is benzalkonium chloride. If a
product causes irritation or if soft contact lenses are worn, consider switching to one that
is preservative-free. If more than six applications are used daily, consider using a
preservative free product as the risk of irritation from the preservative increases with the
frequency of dosing.
4-Sodium chloride (saline) is short acting and suitable as a comfort drops or for use with
contact lenses.

5-Eye ointments containing a paraffin can be used to lubricate the eye surface, especially in
cases of recurrent corneal epithelial erosion. They may cause temporary visual disturbance
and are best suited for application before sleep. Ointments should not be used during
contact lens wear.

6-Sodium hyaluronate eye drops are also used in the management of tear deficiency.

7-Ciclosporin eye drop [to be applied to the affected eye(s) at bedtime] is licensed for
severe keratitis in patients with dry eye disease, which has not improved despite
treatment with tear substitutes.

Scientific name Trade names Dosage form

Dextran Tear naruale Eye drop
hypromellose
Sod. Hyaluronate Hyfresh Eye drop
Hylo- tear
 Anti-glaucoma Drugs

1-Glaucoma characterized by a loss of visual field associated with optic

nerve damage. While glaucoma is generally associated with raised intra-
ocular pressure (IOP), it can occur when IOP is within the normal range.

‫ز‬
‫ بينما يرتبط‬.‫يتمي الجلوكوما بفقدان المجال البرصي المرتبط بتلف العصب البرصي‬
‫ز‬
‫ إال أنه يمكن أن يحدث عندما يكون‬، (IOP) ‫العي‬ ‫الجلوكوما عموما بارتفاع ضغط‬
. ‫ضمن المعدل الطبيع‬IOP

Glaucoma is a disease that damages your eye’s optic nerve.

It usually happens when fluid builds up in the front part of
your eye. That extra fluid increases the pressure in your
eye, damaging the optic nerve.

https://www.aao.org/eye-health/diseases/what-is-glaucoma
2-The most common form of glaucoma is primary open-angle glaucoma, where drainage of
the aqueous humor is restricted. Patients with ocular hypertension are at high risk of
developing primary open-angle glaucoma.

3-Acute angle-closure glaucoma is less common and occurs when the outflow of aqueous
humour from the eye is totally obstructed. It is a medical emergency that requires urgent
reduction of IOP to prevent loss of vision.

1- Ocular Hypotensive Lipids

1-The ocular hypotensive lipids are considered first-line agents because of their superior
efficacy and safety profiles.

2-Prostaglandin analogs offer once-daily dosing, better IOP reduction, good tolerance,
and availability of lowercost generics.

3-The ocular hypotensive lipids are administered once daily at bedtime and should not be
increased to twice daily, as this may decrease effectiveness.

4-The ocular hypotensive lipids are well tolerated and rarely cause systemic side effects
(headache has been reported). Local effects include conjunctival hyperemia, stinging on
instillation, increase in iris pigmentation, deepening of the upper eyelid sulcus,
[hypertrichosis, and darkening of the eyelashes (reversible upon stopping treatment)].

5-Increased iris pigmentation appears to be only a

cosmetic effect.
6-Conjunctival hyperemia or engorgement of
conjunctival blood vessels is a common adverse effect
caused by a vasodilatory effect. It is most prominent
early in therapy and usually subsides over time.
Although generally a benign adverse effect, patients
may have a concern if it affects their cosmetic
appearance.
7-Changes in eye color: Before initiating treatment, patients should be warned of a
possible change in eye color as an increase in the brown pigment in the iris can occur,
which may be permanent; particular care is required in those with mixed colored irides
and those receiving treatment to one eye only.

8-Patients should also be advised to avoid repeated contact of the eye drop solution
with skin as this can lead to hair growth or skin pigmentation.

9-Patients receiving latanoprost or tafluprost should be instructed to refrigerate

unopened medication. Once open latanoprost can stored at room temperature for 6
weeks. Tafluprost single-use containers can be stored at room temperature for up to 28
days.

2- Adrenergic Antagonists

1-Topical β-blockers are typically administered twice daily. A gel-forming solution of

timolol (Timoptic-XE) can be administered once daily

2-Tachyphylaxis may occur in 20% to 50% of patients on monotherapy with a β - blocker,

resulting in the need for a different agent or combination therapy
3-β-Blockers can cause significant systemic adverse effects through nasolacrimal drainage and
subsequent systemic absorption. Bronchospasm is the most common pulmonary effect of
topical β -blockers. Patients prescribed topical β- blockers should be counseled on the
nasolacrimal occlusion technique to decrease systemic absorption.

4-Topical β-blockers are generally contraindicated in patients with asthma, chronic

obstructive pulmonary disease (COPD), sinus bradycardia, second- or third-degree heart
block, cardiac failure, and hypersensitivity to the product.

5-Stinging of the eyes upon instillation is the most common adverse effect.

3- α2-Adrenergic agonists (brimonidine and apraclonidine)

1-Apraclonidine is often used for the prevention and treatment of postsurgical IOP
elevations and is no longer commonly used for long-term treatment of POAG because of
tachyphylaxis and high rate of blepharoconjunctivitis.

2-Brimonidine-purite 0.1% and 0.15% solution (Alphagan-P) (preserved with purite rather
than benzalkonium chloride) has similar efficacy compared with the brimonidine 0.2%
solution, because the purite solution‘s higher pH allows for more drug to penetrate the
cornea.

3-Brimonidine cause both local and systemic effects. Local effects include
blepharoconjunctivitis, conjunctivitis, and ocular allergy. Systemic effects include
headache, dry mouth, and fatigue.
 4- Carbonic anhydrase inhibitors

1-Dorzolamide and brinzolamide are administered every 8 hours and are used as adjunctive
therapy or as monotherapy for patients who cannot tolerate first-line therapies.
Nasolacrimal occlusion may allow for an every-12-hour dosing interval.

2-Local side effects include burning, stinging, itching, foreign body sensation, dry eyes, and
conjunctivitis. Brinzolamide may have fewer incidences of these side effects since the drug
is in a neutral pH solution.

3-Both topical carbonic anhydrase inhibitors are sulfonamides and are contraindicated in
patients with history of sulfonamide hypersensitivity.

1-The systemic carbonic anhydrase inhibitors (e.g. acetazolamide given by mouth or by

injection) are reserved as third-line to fourth-line agents because of their significant
adverse effects.

2-The systemic carbonic anhydrase inhibitors are associated with significant adverse
effects that include paresthesias of the hands and feet.

3-Sulfonamide allergy is a contraindication of systemic carbonic anhydrase inhibitor

therapy.
4-Note: Acetazolamide is also used for epilepsy.
]
 5- Netarsudil
Netarsudil is the first approved Rho kinase inhibitor. Efficacy appears to be similar to
that of β-blockers. It may be used in combination therapy.

6- Sympathomimetic
(Dipivefrin) and parasympathomimetics [directacting cholinergic agents: pilocarpine;
indirect-acting cholinergic agents: echothiophate]

These classes are reserved for last-line use due to multiple daily administrations and
increased side effects. Common side effects include blurred vision, myopia, and brow
ache. Systemic side effects include headache, tachycardia, and increased blood pressure.

7- Hyperosmotics
1-Glycerin, isosorbide, and mannitol are hyperosmotic agents
that increase the osmolality of blood. These agents create an
osmotic gradient that draws water from the vitreous humor,
thus decreasing IOP.

2-The resulting dehydration of the vitreous humor may cause

posterior movement of the lens, which then causes the anterior
chamber to deepen, thus opening the anterior angle.

3-If the patient is not vomiting, glycerin solution and isosorbide can be given orally. If the
patient has nausea or vomiting, mannitol (20%) can be given IV.
Scientific name Trade names Dosage form
Timolol maleate 0.25% ,
Timoptol (MSD) Eye drop
0.5%
Catanoprost Xalatan Eye drop
Brimonidine tartarate Alphagan Eye drop
Dorzolamide HCl Trusept Eye drop
Travaprost Travatan Eye drop
Betaxalol HCl Betoptic Eye drop
 Miscellaneous ophthalmological products

1-Antimuscarinics dilate the pupil and paralyse the ciliary muscle. Short-acting, relatively
weak mydriatics, such as tropicamide (lasts for 4–6 hours), facilitate the examination of the
fundus (funduscopy) of the eye (be applied 20 minutes before examination). Longer acting
options include (action up to 24 hours) or atropine sulfate (action up to 7 days).

2- phenylpherine is used for mydriasis in diagnostic or therapeutic procedures; mydriasis

occurs within 60–90 minutes and lasts up to 5–7 hours.

3-Mydriatics and cycloplegics are used in the treatment of anterior uveitis, usually as an
adjunct to corticosteroids.

‘ may be used as an antiseptics before ocular surgery.

Acetylcholine chloride irrigation (powder and solvent) is used for during some eye surgery
requiring rapid complete miosis.

1-Oxybuprocaine and (eye drops) are widely used topical local anaesthetics. Tetracaine
produces a more profound anesthesia and is suitable for use before minor surgical
procedures, such as the removal of corneal sutures.
2-Lidocaine, with or without adrenaline/epinephrine is injected into the eyelids for minor
surgery.

Sodium chloride may be used for tear deficiency, irrigation, including first-aid removal of
harmful substances, intra-ocular or topical irrigation during surgical procedures.