[...]... reaction usually occurs locally in the ocular tissues Occasionally, as in erythema multiforme potentiated by sulfonamide agents, adverse reactions can manifest as a systemic response 7 Ocular Effects of Locally Administered Drugs Numerous adverse ocular effects from topically administered drugs have been observed (Box 1-2).These occur through a variety of mechanisms Ocular tissues respond by manifesting... with ocular pharmacotherapeutic agents Such interactions can play a significant role in enhancing drug effects and may exacerbate adverse reactions Several drug–drug interactions between ocular antiglaucoma and systemic medications have been well documented (Table 1-1) Patients with cardiac disease who are treated with potent inotropic agents such as dopamine or dobutamine should not be given topical ocular. .. understanding more complicated treatments Clinical Examination Physical Limitations Affecting Compliance Unlike oral drug therapy in which the dosage unit is usually a tablet or capsule that is swallowed, ocular pharmacotherapy requires a measure of manual dexterity if topical solutions or ointments are to be instilled successfully.When patients cannot successfully instill their ocular medications independently,... appropriate pharmacotherapy for the patient (Box 1-1) Ocular History Clinicians should ask about past and current eye disease as well as past ocular trauma Practitioners should inquire about a history of contact lens wear Many topically applied medications can cause corneal complications when used in the presence of soft contact lenses Obtaining a history of current ocular medications is essential If their continued... of the clinically important systemic effects caused by topical ocular medications Adherence to the following guidelines can reduce systemic drug absorption and reduce the risk of adverse reactions: ● Advise patients to store all medications out of children’s reach.Twenty drops of 1% atropine can be fatal if swallowed by a child CHAPTER 1 Pharmacotherapy of the Ophthalmic Patient 9 Table 1-2 Clinically... reach.Twenty drops of 1% atropine can be fatal if swallowed by a child CHAPTER 1 Pharmacotherapy of the Ophthalmic Patient 9 Table 1-2 Clinically Significant Systemic Effects Caused by Ocular Medications Ocular Drug Clinical Circumstance Under Which Adverse Effect Occurs β-Blockers Treatment of open-angle glaucoma Brimonidine Treatment of open-angle glaucoma Echothiophate Treatment of open-angle glaucoma... Pharmacotherapy of the Ophthalmic Patient Kaplan S The importance of the therapeutic alliance J Am Optom Assoc 1998;69:637–642 Khurana RN, Lee PP, Challa P Readability of ocular medication inserts J Glaucoma 2003;12:50–53 Mauger TF, Craig EL Havener’s ocular pharmacology, ed 6 St Louis, MO: Mosby, 1994 McPhillips R Can the elderly afford eye care? Can we afford eye care for the elderly? Ophthalmology 1987;94:1199–1204... penicillins or cephalosporins, and those allergic to sulfonamides should not be given topical ocular sodium sulfacetamide or carbonic anhydrase inhibitors Narcotic analgesics should be avoided in patients allergic to opioids Cross-sensitivity of proparacaine with other local anesthetics is rare and usually not an important clinical consideration (see Chapter 6) A history of hypersensitivity to specific local... helpful in identifying contraindications to drug use Studies have demonstrated that approximately 70% of the first-degree offspring of individuals with primary open-angle glaucoma have clinically significant elevations of intraocular pressure (IOP) when given topical steroids long term When topical steroid therapy is contemplated in close relatives of individuals with glaucoma, steroids less likely to elevate... important decisions to make when instituting ocular pharmacotherapy In most cases this is straightforward Eyedrops, formulated for topical ophthalmic use only, are used as diagnostic agents for patients undergoing tonometry or pupillary dilation Patients with infectious or inflammatory disease, however, can be given therapeutic agents in a variety of forms Most ocular surface infections, such as blepharitis . 11830 Westline Industrial Drive St. Louis, Missouri 63146 CLINICAL OCULAR PHARMACOLOGY ,FIFTH EDITION ISBN: 978-0-7506-7576-5 Copyright © 2008 by Butterworth-Heinemann,. concepts be introduced to students and practitioners alike. This new fifth edition of Clinical Ocular Pharmacology addresses these new concepts and provides “one-stop