Ophthalmic Drugs

By:
Dr. Ahmed Selim
 Antibiotics  Anti-allergic & anti-
 Steroids inflammatory
 Combined AB & steroids  Anti-glaucomatous
 Anti-parasitic  Contact lens solutions
 Anti-viral  Drugs for vascular
 Anti-fungal insufficiency
 Artificial tears  Drugs for hemorrhage &
 Mydriatics active bleeding
 Anesthetics  Vitamins
 Hyper tonic saline 5 %

By: Dr. Ahmed Selim Mansoura Ophthalmic Hospital Written By: Dr. Maroa Nabih
 1-Antibiotics
A-Broad spectrum
 Fluoroquinolones
 Chloramphenicol
 Tetracycline
 Sulphonamide-
 Cephalosporine
B- Gram +ve
 Vancomycin
 Fucidic acid
C- Gram –ve
 Aminoglycosides
 Polymixin B

Routes
 Topical
 Fortified
 Sub-Conjunctival
 Intra-Vitreal
 Systemic

By: Dr. Ahmed Selim Mansoura Ophthalmic Hospital Written By: Dr. Maroa Nabih
 TOPICAL
1-Fluoroquinolones : broad spectrum but relatively weak against
streptococci
-1st generation
- 2nd generation:
a- Ciprofloxacin (Ciprocin ED & EO – Ciloxan ED )
b- Oflxacin (oflox-ofloxin-optiflox) ED
c- Lomeflxacin (orchacin) ED
-3rd generation
a- levofloxacin (levoxin) ED
-4th generation
a- Gatifloxacin (zymar-tymer-gatistar-occubact-pharmagatin-gatipram-
gatilox) ED
b- Moxifloxacin (vigamox-fortymox-fluoroquinomox) ED
Generation G +ve G -ve
st
1 + ++++
nd
2 ++ ++++
rd
3 +++ ++++
th
4 ++++ ++++

N.B : gatifloxacin and moxifloxacin are the newest 4th generation ,but
moxifloxacin is superior to gatifloxacin in ocular penetration .

2-Chloramphenicol : broad spectrum but not effective against

pseudomonas
-drug of choice as 1st line of ocular surface infections
-ex : isoptophenicol ED
-contra indicated in Aplastic anemia

3-Tetracycline: broad spectrum, but not effective against

pseudomonas
-Drug of choice in angular blepharitis , trachoma & all staph infections
(lid infections)

By: Dr. Ahmed Selim Mansoura Ophthalmic Hospital Written By: Dr. Maroa Nabih
-ex: oxypol EO – terramycin EO
4-sulphonamide : broad spectrum
-ex : ocusul ED – isoptocetamide ED
-contraindicated in G6PD defecincy

5- vancomycin: G+ve (fortified)

6- fucidic acid: G+ve (safest g+ve in children)

-ex :fucithalmic EO – optifucin ED – futhalm ED

7- Aminoglycosides: G-ve and specific for pseudomonas

A-Gentamycin (optigent-apigent-gentamycin)ED
B-Tobramycin :(Tobrin-Tobrex-avazir)ED…..safest G-ve in
children and superior to gentamycin
C-Amikacin (fortified amikin)
D-Neomycin (Neopol- Neomyxidin)ED
- Neopol contain neomycin & polymixin B while neomyxidin
contain neomycin- polymixin B & gramicidin
- Neomycin can be used in ttt of Acanthameoba & not
effective against pseudomonas

8- Polymixin B : G-ve & effective against some types of Pseudomonas

9- Cephalosporines : Broad spectrum "Fortified"

Generation G+ve G-ve
st
1 ++++ +
nd
2 +++ ++
rd
3 ++ +++
th
4 + ++++
nd
2 generation :cefuroxime (Zinnat- Zinacef)
3rd generation : ceftazidim (Fortum)
By: Dr. Ahmed Selim Mansoura Ophthalmic Hospital Written By: Dr. Maroa Nabih
 Fortified
1-Gentamycin or Tobramycin (15mg /ml)
2ml parentral "40mg/ml" ampoul
added to commercially available (gentamycin – Tobramycin) 0.3%
eyedrop
2-cefuroxime or vancomycin(50mg/ml)
500 mg parentral vial
is dil in 2.5 ml water then added to 7.5 ml tear sustitute
3- Fluconazole :Diflucan vial 100mg
without dil
4-Amphotericin B (1.5mg/ml)
Fungizone 50 mg
dil in 10 ml water
Take 3 ml - add 7 ml water

Sub-conJunctival
Commercially Volume Volume for Dose
available added injection
Vancomycin 500 mg vial 50 ml 0.25ml 25mg
ceftazidime 500 mg vial 2.5 ml 0.5ml 100mg
cefuroxime 500 mg vial 2 ml 0.5ml 125mg
Amikacin 500 mg vial 2 ml 0.4ml 100mg
Gentamycin 80mg/2ml 0.5ml 20mg
ampoule
Dexamethasone 8mg/2ml 0.5ml 2mg
ampoule
Atropine 1mg/1ml 0.5ml 0.5mg
ampoule

By: Dr. Ahmed Selim Mansoura Ophthalmic Hospital Written By: Dr. Maroa Nabih
 Intra-vitreal

1-vancomycin: 1mg/0.1ml
Vancomycin 500mg vial
- Dil in 10 ml
- take 1ml
- Dil in 5ml "add 4 ml"

2-ceftazidime : 2.25 mg/0.1ml

Fortum 500mg vial
- Dil in 10ml
- take 1ml
- Dil in 2.2ml "add 1.2 ml"

3- Amikacin : 0.4mg/0.1ml
Amikacin 500 mg vial
-Dil in 10 ml
-take 0.8 ml
-Dil in 10 ml "add 9.2 ml"

4- Triamcinolone : 4mg/0.1 ml
Kenacort A 40 mg/ml
-Without dil

5-Amphotericin B : 0.005mg/0.1ml
Fungizone 50mg vial
-Dil in 10 ml
-take 0.1 ml
-Dil in 10 ml "add 9.9 ml"

By: Dr. Ahmed Selim Mansoura Ophthalmic Hospital Written By: Dr. Maroa Nabih
 Systemic A.B
--lipid soluble has better ocular penetration than water soluble
--Most common systemic A.B used in ocular diseases are:
1- Tetracycline:
Ex: tetracycline 250mg tab twice daily
Doxycycline 100mg tab twice daily
- Used for its antibiotic effect in ttt of recurrent blepharitis & lid infections
- Used for its anticollagenase effect in ttt of chemical injury ,recurrent corneal
erosins &corneal thinning or melting as with corneal abcess

2- Ciprofloxacin:
- Ciprofloxacin 750mg tab twice daily
Used when ulcer or abcess is close to limbus to prevent involvement of sclera
(pan ophthalmitis)

3-Azithromycin:
-xithrone 500mg tab "2 tabs once"
Specific for active trachoma

4-Amoxicillin+clavulinic acid : Augmentin

Can be used in ttt of dacryocystitis

5-Erythromycin :
Erythrin syrup 125 mg
Used in childhood blepharokeratoconjunctivitis (BKC)

6- Averozolid: 600mg tab twice daily

Used for severe G+ve infections (as vancomycin)

7- Triple therapy for orbital cellulitis :

G+ve : vancomycin
G-ve :ceftazidime
Aerobes: metronidazole
Till the ptn is Apyrexial for 4 days

By: Dr. Ahmed Selim Mansoura Ophthalmic Hospital Written By: Dr. Maroa Nabih
 2-Steroids
Side effects:
1-complicated cataract
2-increase IOP
3-Delay corneal epithelial healing (melting & perforation)

A) Topical steroids
For severe 1-Hydrocortisone E.O (0.5% -1%)
inflammation 2-Prednisolone ED :
-predforte -salcodine
-optipred -echopred
-pharmapred
-orchapred

For moderate 1-dexamethasone ED-EO-GEL:

inflammation -Dexonium -dexagal
-Epidexone -dexasine
-Isoptomaxidex
2-Rimexolone ED
-Vexol
For mild inflammation 1-Fluorometholone ED
(weakest with least side -FML
effect)

B) Systemic steroids
1- Oral : prednisolone (Hostacortine-solupred)
1-2 mg/kg/day
2- IV injection methyl prednisolone
Ex : solumedrol vial
1gm/day for 2-3 days
-Betamethasone: Deprofos amp once

By: Dr. Ahmed Selim Mansoura Ophthalmic Hospital Written By: Dr. Maroa Nabih
 3-Combined
Dexatrol Polymixin B + G-ve
Maxitrol Neomycin +
Dexa
Optidex T Tobramycin + G-ve
Tobradex Dexa
Co-Avazir
Dexatobrin
Blephamide Sulfa + Broad spectrum
Isoptocetapred Dexa
Terracortil Tetracyclin + Broad spectrum
Hydrocortisone
Orchadexoline Chloramphenicol + Broad spectrum
Dexa +
Tetrahydrozoline
Dexaflox Ofloxacin + Broad spectrum
Dexa

4-Anti Parasitic
For Acanthamoeba
-propamedine isetionate : Brolene ED

By: Dr. Ahmed Selim Mansoura Ophthalmic Hospital Written By: Dr. Maroa Nabih
 5-Anti Viral
A)Topical
1-Acycloguanine: (Zovirax –Acyclovir E.O)
- 5 times daily
-relatively nontoxic, can be used for 60 days
-superior to other antiviral in ocular penetration
-95% of dendritic ulcer relief within 2 w
2-Trifluorothymidine (Bephen E.D)
-every 2 h
-more toxic to conjunctiva and corneal epithelium than
acycloguanosine
3- Adenine Arabinoside (Vidarabine EO)
-in cases resistant to acycloguanosine & trifluorothymidine

B)Systemic
Used for
1-recurrent HSV or HZO
-Acyclovir 800 mg 1x5x7
-Zovirax 800 mg 1x5x7
2- for viral uveitis
-Foscarnet
-Valganocyclovir
-cidofovir
-Gancyclovir

C)Skin topical
For HZO shingles: Zovirax skin oint + A.B oint + steroid oint

By: Dr. Ahmed Selim Mansoura Ophthalmic Hospital Written By: Dr. Maroa Nabih
 6-Anti Fungal
Fungi : -yeast : candida
-Filamentous : Aspergillus - Fusarium
1-Polyenes:
-Amphotericin B : for candida & Aspergillus
-Natamycin : for Fusarium

2-Imidazoles
-Econazole : yeast & Filamentous & acanthameba
-ketoconazole(Nizoral) : yeast & Filamentous
-Fluconazole (Deflocan) : candida
-Itraconazole : Candida & asperagillus
-Voriconazole : broad spectrum superior to other antifungal in
effect and ocular penetration
3- Flucytosine

7-Hypertonic saline
-Hypertonic saline 5% "Nacl 5%"
Ex : optic saline : used in corneal edema

8-Artificial tears
1-HPMC (hydroxy propyl methyl cellulose)
-tears guard ED
-tears natural ED
-normotears ED (more viscous)
-Artelac ED

2-CMC (carboxy methyl cellulose) superior to HPMC

- Refresh tears ED
- Refresh tears plus (preservative free)
By: Dr. Ahmed Selim Mansoura Ophthalmic Hospital Written By: Dr. Maroa Nabih
- Refresh tears liquigel (more viscous)
-Optive ED ( CMC+ glycerine)

3-Sodium hyaluronate : used in severe dryness and post lasik

-Hyfresh ED
-Polyfresh ED
-lubrivisic ED

4-Vitamin A palmitate : help to increase epithelialization

-cornetears ED
-Hypotears GEL

5-Dexapanthenol : for Keratitis

-corneregel ED & GEL

6-carbomer: gel for prolonged duration

-Genteal GEL
-Thilotears GEL
-Vidisic GEL
7-Polyethylene glycol : most recent
-systane ED
-systane ultra ED

8-Polyvinyl Alcohol :
-Liquifilm ED

9-Polyvinyl Pyrrolidone :
-Vidisept N ED

10-Cyclosporine: has anti-inflammatory effect

-Restasis ED

11-BSS:
-Balanced salt solution

By: Dr. Ahmed Selim Mansoura Ophthalmic Hospital Written By: Dr. Maroa Nabih
 9-Mydriatics &cycloplegics
Used for:
 fundus examination
 Pre cataract extraction surgery
 Accomodation paralysis
 corneal ulcer to relief ciliary spasm
 Uveitis to prevent synechia formation
 Hyphema to maintain constant pupil
 Pupillary block
N.B: Mydriatics have cycloplegic effect except phenylephrine
Ex :
-Atropine : Isopto atropine "14 d"
-Cyclopentolate : cycloplejeco – Plegica " 24 h"
-Tropicamide : mydrapid –mydriacyl "6 h"
-phenylephrine : "3 h"
cyclophrine :
Cyclopentolate
Phenylephrine

10-Anaesthetics
-Benoxinate : Benox E.D
N.B: Epitheliotoxic

By: Dr. Ahmed Selim Mansoura Ophthalmic Hospital Written By: Dr. Maroa Nabih
 11-Anti allergic+ Anti inflammatory
1-Anti histaminic : standard
2-Mast cell stabilizers standard
3-Decongestant : adjunctive to anti-H to relief symptoms
4-NSAIDs : adjunctive to anti-H to relief symptoms
5- Steroids :in resistant cases
6-Combination

1-Anti Histaminic: for acute attack ,not for long duration

Ex :
-Levocabastine : Levostin ED
-cetirizine : cetirizine ED
-emedastine : Emadine ED
-Epinastine : Relestat ED
*other anti histaminic used in combination :
-pheneramine
-chlorpheneramine
-Diphenylhydramine
-Antazoline

2- Mast cell stabilizers : for prophylaxis, used for long duration

except lodoxamide
Ex :
-pemirolast : Mirolast ED
-Na chromoglycate : epichrome ED -optichrom ED –visichrom ED
-Lodoxamide : Alomide ED – thilomide ED

3-Decongestant :
-Naphazoline : Visine ED
-Tetrahydrozoline : Berberil N ED – Eye clear ED
-phenylephrine : phenylephrine ED – Prefrin ED
N.B : Prolonged use leads to rebound V.D ,dryness & decrease
corneal healing

By: Dr. Ahmed Selim Mansoura Ophthalmic Hospital Written By: Dr. Maroa Nabih
4-NSAIDs :
Uses :
 Ocular surface inflammation
 prevent intra operative miosis
 prophylaxis against post operative cystoid macular
oedema " Irvine Gass syndrome"
Ex :
-Diclofenac : voltaren ED –epiphenac ED – Romalex ED-Declophen ED
-Ketorlac : Acular ED– Ketorlac ED
-Flubiprofen : Ocufen ED – sigmaprofen ED
-Nepafenac : Nevanac ED

5- Combinations :
1-Anti H + mast cell stabilizers
-Ketotifen : Orchazid ED ,Mastosytex ED &Zaditen ED
-Olopatadine : Patanol ED, olohistine ED & conjyclear ED
-Azylastine : Azylast ED
2-Anti H + decongestant :
- Naphazoline + pheneramine : Naphcon A ED
- Naphazoline +chlorpheneramine: Nostamin ED & Prisoline ED
- Naphazoline + diphenylhydramine :Occumethyl ED
3-Steroid +Mast cell stabilizers:
Ex : Fluca ED (Fluorometholone+Na chromoglycate)
4-Steroid +Decongestant:
-Isoptosterofrin ED (prednisolone+ phenylephrine)
5- Decongestant +tear substitute :
Ocutal tec ED (phenylephrine +HPMC)
6- Anti H +Decongestant+tear substitute :
Trillerg ED(tetrahydrozoline+Antazoline+HPMC)

By: Dr. Ahmed Selim Mansoura Ophthalmic Hospital Written By: Dr. Maroa Nabih
 Drugs containing Zinc

-Visine AC ED :Visine +zinc sulfate

-Prisoline zinc ED : prisoline + zinc sulfate
-Zinc frin ED: phenylephrine + zinc sulfate
N.B: Zinc Sulphate is used to :
a)relief discomfort & ocular irritation
b)can be used in Angular blepharitis to neutralize toxins of
Moraxella

By: Dr. Ahmed Selim Mansoura Ophthalmic Hospital Written By: Dr. Maroa Nabih
 12-Anti Glaucomatous

-Beta blockers ….1st line

-PG
-Sympathomimetics
-Miotics
-C.A.Is
-Hyper osmotic agents
-Combinations

A)B.B :
decrease IOP by 20-30 % except Betaxolol (15-20 %)
C.I in cardiac and asthmatic ptn
1-Timolol : 1x2 E.D Timolol ED
1x1 Timogel
-it is non selective B1 & B2 blocker

2-Betaxolol :1x2
-Betoptic ED –Apixol ED
-cardioselective B1 blocker
-effect in lowering IOP is less than Timolol ,but
superior in preserving visual field
-neuroprotective : increase blood supply to optic nerve

3-Metipranolol : 1x2
-Betaophthiol ED
-preservative free : used in allergic ptn
-non selective B1 & B2 blocker
By: Dr. Ahmed Selim Mansoura Ophthalmic Hospital Written By: Dr. Maroa Nabih
4- Levoburolol : 1x1
-Betagan

B)P.Gs
1- Latanoprost : decrease IOP by 25-32 % " 1x1"
Ex : xalatan –Ioprost
2-Travoprost : decrease IOP by 25-32 % "1x1"
Ex : Travatan
3-Bimatoprost : decrease IOP by 27-32% "1x1"
Ex : Lumigan (strongest mono agent)
4-Unoprostone : decrease IOP by 13-18 % "1x2"
Ex :Rescula

-C.I in pregnancy & inflammatory conditions

-cause eyelashes lengthening

C) Sympathomimetics :
1- Adrinaline –Dipivifrin "propine": decrease IOP by 15-20%
2-Brimonidine : decrease IOP by 20-30% "1x2"
Ex : Alphagan – pharmapress –Brimonidine
-Neuroprotective
3-Apraclonidine : decrease IOP by 20-30%
-lower IOP after Laser procedures

D) Miotics : decrease IOP by 15-25 %

Ex : Pilocarpine 1% ,2%,3%,4% E.D
Gel 1x1
- Isoptocapine- Ocucarpine : E.D 1x4
-side effects :
- R.D (long term use)
By: Dr. Ahmed Selim Mansoura Ophthalmic Hospital Written By: Dr. Maroa Nabih
 - Myopic shift
- night vision impairment

E) C.A.Is : decrease IOP by 15-20 %

-Topical : "1x3"
*Dorzolamide : xola ED – Trusopt ED
*Brinzolamide : Azopt ED
-Systemic :
*Acetazolamide : Cidamex 250 tab -Diamox 250 tab
- Hidure 250 tab - Acetamex 250 tab
*Dichlorphenamide : oratrol 50 mg tab

-S.E of C.A.Is is hypokalemia : slow K tab or syrup

F)Combinations:

1-Timolol +Brimonidine (Combigan)

2- Timolo +Brinzolamide (Azarga)
3- Timolol+ Dorzolamide ( cosopt-Twinzol-xolamol-
Glaucosopt-Epizopt)
4- Timolol +Latanoprost (xalacom- Timexal)
5- Timolol +Bimatoprost (Ganfort)
6- Timolol + Travoprost (Duotrav)

G)Hyper osmotic agents :

** for temporary decrease of IOP
**It's effect is limited in inflammatory glaucoma
1- Mannitol 20% (1-2g/kg body wt )
-don't exceed 60 drops/min over 20-30 min
2-Glycerol
3-Isosorbide

By: Dr. Ahmed Selim Mansoura Ophthalmic Hospital Written By: Dr. Maroa Nabih
 13-contact lens solutions
1-Renu (B & lomb)
2-complete (Allergan)
3-Opti free (Alcon)
4-Perfect care (Orchidia)

14-Drugs for vascular insuffeciency

1-Rutin : Ruta C tab ,Rutalex tab
-reduce capillary permeability & leakage for diabetic
retinopathy
2-Ca dobesilate :doxium tab ,Dilasal tab
- reduce capillary permeability & leakage for diabetic
retinopathy
3-Chemotrypsin :
Ex : Alpha chemotrypsin vial
Ambizim tab
Alphintern tab
-Anti oedematous ,anti clotting for
hematomas ,clotted hyphema & vit hge
4-Amylase : Maxilase syrup "children"
- Anti oedematous ,anti clotting for
hematomas ,clotted hyphema & vit hge

By: Dr. Ahmed Selim Mansoura Ophthalmic Hospital Written By: Dr. Maroa Nabih
15-Drugs for Hge & active bleeding
1-Dicynone : Ethamsylate (tab & amp)
2-Cyklokapron : Tranexamic acid (tab & amp)

16-Vitamins used for eye care

1-Vit A "A-viton"
-Def : Dry eye, Keratomalacia "Xerophthalmia"
2-Vit B "neuroton"
-Def : Neuro-retinopathy
3-Vit C "Vitacid"
-def : cataract & sub conj he

**Vit A in defective epithelialization

**Vit C has anti collagenase effect used as tetracycline in cases
of corneal thinning &melting & in chemical injuries
**Vit B used in cases of retinopathies & neuropathies

****Vitamins for cornea :

1-Vit A: increase epithelial healing
2-Vit B: improve corneal metabolism
3-Vit C :Prevent thinning & melting

****Multi vitamins
1-I care: contain Lutein for ARMD
2-Ocuguard & Eye vit : for all cases of retinopathies &
ARMD
3- octatron :multivitamins + antioxidant " selenium"

By: Dr. Ahmed Selim Mansoura Ophthalmic Hospital Written By: Dr. Maroa Nabih