Clinical Ocular Pharmacology (eBook)

Front Cover 1
Clinical Ocular Pharmacology 4
Copyright Page 5
Table of Contents 8
Dedication 6
Contributing Authors 10
Preface 12
Preface to the First Edition 14
PART I: Fundamental Concepts in Ocular Pharmacology 16
CHAPTER 1. Basic Science of Ocular Pharmacology 18
Physicochemical Factors Affecting Drug Bioavailability 18
Ocular Tissue Structure and Pharmacokinetics 20
Compartment Theory and Drug Kinetics 27
Properties of Receptors 29
Properties of Drug Formulations Affecting Bioavailability 33
Ocular Drug Development and the Patient 40
References 40
CHAPTER 2. Clinical Administration of Ocular Drugs 44
Principles of Drug Administration 44
Topical Administration 50
Periocular Administration 66
Intravitreal Administration 70
Intracameral Administration 70
Iontophoresis 71
Oral Administration 71
Parenteral Administration 72
Ophthalmic Prescription Writing 73
Patient Compliance 75
Legal Aspects of Drug Administration 76
References 78
PART II: Pharmacology of Ocular Drugs 82
CHAPTER 3. Drugs Affecting the Autonomic Nervous System 84
Functional Concepts 84
Divisions of the Autonomic Nervous System 86
Adrenergic Innervation to the Eye 88
Adrenergic Agonists 90
Adrenergic Antagonists: ß-Adrenergic Blocking Agents 108
a-Adrenergic Blocking Agents 118
Adrenergic Neuronal Blocking Agents 120
Cholinergic Innervation to the Eye 123
Cholinergic Agonists 124
Cholinergic Antagonists 143
REFERENCES 153
CHAPTER 4. Local Anesthetics 164
Historical Perspective 164
Pharmacologic Properties 165
Injectable Anesthetics 166
Topical Anesthetics 166
Side Effects 170
Contraindications 174
References 176
CHAPTER 5. Anti-Inflammatory Drugs 178
Corticosteroids 178
Ocular Complications 192
Adrenocorticotropic Hormone 197
Nonsteroidal Anti-Inflammatory Agents 197
Cromolyn Sodium (Disodium Cromoglycate) 204
Dimethyl Sulfoxide 206
References 207
CHAPTER 6. Anti-Infective Drugs 214
Guidelines for Effective Antimicrobial Therapy 214
Drugs Affecting Cell Wall Synthesis 219
Drugs Affecting the Cytoplasmic Membrane 227
Drugs Affecting Protein Synthesis 228
Drugs Affecting Intermediary Metabolism 237
Drugs Affecting Bacterial DNA Synthesis 242
References 254
CHAPTER 7. Inhibitors of Aqueous Formation 260
Aqueous Humor Formation 260
ß-Adrenergic Blocking Agents 262
Carbonic Anhydrase Inhibitors 269
Cannabinoids 278
Recent Developments 281
References 281
CHAPTER 8. Hyperosmotic Drugs 290
Corneal Hydration 290
Topical Hyperosmotic Agents 291
Systemic Osmotherapy 293
References 297
CHAPTER 9. Irrigating Solutions 300
Desirable Properties of Irrigating Solutions 300
Extraocular Irrigating Solutions 307
Intraocular Irrigating Solutions 309
References 312
CHAPTER 10. Lubricants and Other Preparations for the Dry Eye 316
Tear Film Physiology 316
Tear Film Abnormalities 318
Composition of Tear Substitutes 319
Punctal Plugs 325
References 326
CHAPTER 11. Antihistamines 328
Hypersensitivity Reactions 328
Histamine 329
H, Antihistamines 332
H2 Antihistamines 336
References 336
CHAPTER 12. Dyes 338
Fluorescein and Derivatives 338
Méthylène Blue 347
Indocyanine Green 348
Alcian Blue 348
Trypan Blue 348
References 348
CHAPTER 13. Preparations Used with Contact Lenses 352
Physiochemical Properties of Contact Lens Solutions 352
Preservatives and Disinfectants 353
Wetting Agents 363
Lubricants 364
Cleaning Agents 364
Soaking (Storage) Agents 364
Polishing Compounds 366
Decongestant Agents 367
References 367
PART III: Ocular Drugs in Clinical Practice 370
CHAPTER 14. Contact Lens Solutions in Clinical Practice 372
Solutions Used with Nonhydrogel Lenses 372
Solutions and Systems Used with Hydrogel Lenses 381
References 399
CHAPTER 15. Topical Anesthesia 402
Selection of Anesthetic 402
Clinical Utilization 403
References 409
CHAPTER 16. Dilation of the Pupil 412
Incorporation of Pupillary Dilation into Examination Routine 412
Anterior Angle Evaluation 414
General Considerations and Guidelines 418
Dilation Drug Regimens 419
Clinical Procedures Facilitated by the Use of Mydriatics 426
Postdilation Procedures 432
Pupillary Dilation as a Therapeutic Procedure 433
Complications 434
References 435
CHAPTER 17. Cycloplegic Refraction 440
Indications and Advantages 440
Precautions and Contraindications 441
Disadvantages 441
Selection and Use of Specific Cycloplegic Agents 442
Clinical Procedure 444
Adverse Reactions 447
References 447
CHAPTER 18. Abnormalities of the Pupil 450
Clinical Evaluation of Anisocoria 450
Guidelines for the Pharmacologie Evaluation of Anisocoria 452
Physiologic Anisocoria 452
Homer's Syndrome 453
Adie's Syndrome 462
Unilateral Fixed and Dilated Pupil 466
References 471
CHAPTER 19. Diseases of the Eyelids 474
Clinical Anatomy and Physiology 474
Congenital Abnormalities 474
Abnormalities Associated with Trauma 475
Inflammatory Diseases 477
Abnormalities of Motility 494
Abnormalities of Lid Margin Position 498
Benign Tumors 502
References 503
CHAPTER 20. Diseases of the Lacrimal System 510
Clinical Anatomy and Physiology 510
General Examination Procedures 513
Dacryoadenitis 517
Blink, Lid, and Lash Disorders 517
Disorders of the Tear Film 518
Disorders of Lacrimai Drainage 524
Acquired Dacryocystitis 530
References 530
CHAPTER 21. Diseases of the Conjunctiva 534
Histology of the Conjunctiva 534
Conjunct!vai Inflammation 535
Laboratory Evaluation of Conjunctival Disease 535
Microbiology of the Conjunctiva 538
Papillary Conjunctivitis 538
Follicular Conjunctivitis 556
Mechanical and Toxic Conjunctivitis 568
The Conjunctiva in Systemic Diseases and Syndromes 570
Miscellaneous Conjunctival Disorders 576
References 582
CHAPTER 22. Diseases of the Cornea 586
Examination 586
General Forms of Superficial Keratitis 587
Conditions Affecting the Inferior Cornea 588
Conditions Affecting the Central Cornea 592
Conditions Affecting the Superior Cornea 593
Conditions Causing Diffuse Superficial Keratitis 596
Conditions Causing Superficial Keratitis of Random Distribution 601
Conditions Affecting the Limbus 602
Central Corneal Ulcers 603
Interstitial Keratitis 613
Degenerative Processes 614
Corneal Dystrophies 618
Injuries of the Cornea 620
References 627
CHAPTER 23. Diseases of the Sclera 632
Episcleritis 632
Scleritis 634
References 639
CHAPTER 24. Uveitis 642
Definition and Classification 642
Epidemiology 642
Diagnosis 643
Etiology 643
Management 645
Specific Uveitides 647
References 656
CHAPTER 25. Diseases of the Retina 658
Specialized Clinical Testing Techniques for Retinal Disease 658
Retinal Vascular Occlusive Disease 662
Diabetes and Diabetic Retinopathy 670
Hereditary Diseases 674
Acquired or Degenerative Diseases 674
Inflammatory Diseases 675
Acquired Immunodeficiency Syndrome 682
References 685
CHAPTER 26. Diseases of the Optic Nerve 696
Clinical Anatomy of the Optic Nerve 696
Diagnosis of Optic Nerve Disease 697
The Optic Neuropathies 700
Papilledema 709
Nutritional and Toxic Optic Neuropathy 712
References 713
CHAPTER 27. Thyroid-Related Eye Disease 718
Epidemiology 718
Etiology 718
Diagnosis 719
Clinical Course of Graves' Ophthalmopathy 728
Management 729
References 740
CHAPTER 28. Pharmacologic Management of Strabismus 744
Accommodative Esotropia 744
Use of Botulinum Toxin 748
References 750
CHAPTER 29. The Glaucomas 752
Classification 752
Basic Etiology 752
Pathogenesis 754
Epidemiology 756
Ocular Hypotensive Agents 758
Congenital Glaucoma 758
Primary Angle-Closure Glaucoma 761
Primary Open-Angle Glaucoma 767
Low Tension Glaucoma 792
Secondary Angle-Closure Glaucoma: Neovascular Glaucoma 797
Secondary Open-Angle Glaucoma 799
References 808
PART IV: Toxicology 818
CHAPTER 30. Ocular Effects of Systemic Drugs 820
Determinants of Adverse Drug Reactions 820
Ocular Manifestations of Systemic Drug Therapy 822
Drugs Affecting the Conjunctiva and Lids 830
Drugs Affecting the Lacrimai System 832
Drugs Affecting the Pupil 834
Drugs Affecting Extraocular Muscles 835
Drugs Causing Myopia 836
Drugs Causing Cycloplegia 837
Drugs Affecting Intraocular Pressure 837
Drugs Affecting the Retina 839
Drugs Affecting the Optic Nerve 852
Prevention of Adverse Reactions 854
References 854
CHAPTER 31. Systemic Effects of Ocular Drugs 862
Epidemiologic Methodology 863
Anticholinergic Agents 864
Cholinergic Agonists 867
Adrenergic Agonists 868
Adrenergic Blocking Agents 870
Anti-Infective Agents 871
Systemic Emergencies 874
Summary 878
References 879
PART V: Legal Aspects of Drug Utilization 882
CHAPTER 32. Legal Basis for Drug Use in Optometry 884
Legislative Authorization 885
Judicial Regulation 885
Administrative Regulation 886
Delegations of Authority 886
References 887
CHAPTER 33. Informed Consent 888
Disclosure Requirements 888
The Duty to Disclose Risks of Proposed Treatment 889
Alternatives to Therapy 891
Disclosure of Abnormalities 891
References 892
CHAPTER 34. Negligence 894
Proof of Negligence 894
Standard of Care 896
Misdiagnosis 897
Complications of Diagnostic Drug Use 899
Complications of Therapeutic Drug Use 900
Documentation 902
References 902
CHAPTER 35. Product Liability 904
Basis for Product Liability 904
Ophthalmic Drugs and Liability Claims 906
Documentation 907
References 907
Index 910