Postoperative Flat Anterior Chamber Medication

Author: James V Aquavella, MD; Chief Editor: Hampton Roy Sr, MD more...

Updated: Feb 16, 2010

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Medication Summary
Osmotic diuretics
Carbonic anhydrase inhibitors
Beta-blockers
Cycloplegics and mydriatics
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Medication Summary

Topical steroids are used to reduce inflammation postoperatively. The following topical eye drops, used singularly or combined for elevated pressure, may be used: beta-blockers, alpha-2 adrenergic agonist, prostaglandins, carbonic anhydrase inhibitors (topical or systemic), miotics, and sympathomimetics. Topical cycloplegic agents may be used in a shallow chamber associated with choroidal detachment or cyclodialysis clefts. Topical antibiotics are indicated in the presence of wound leaks.

Class Summary

These agents are used to reduce pressure elevations associated with pupillary block. Osmotic agents increase the osmolarity of the glomerular filtrate and induce diuresis. This, in turn, hinders the tubular reabsorption of water, causing sodium and chloride excretion to increase.

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Mannitol (Osmitrol, Resectisol)

For acute elevations, has a rapid onset. Reduces elevated IOP when the pressure cannot be lowered by other means.

Initially assess for adequate renal function in adults by administering a test dose of 200 mg/kg, given IV over 3-5 min. Should produce a urine flow of at least 30-50 mL/h of urine over 2-3 h.

In children, assess for adequate renal function by administering a test dose of 200 mg/kg, given IV over 3-5 min. Should produce a urine flow of at least 1 mL/kg over 1-3 h.

Class Summary

These agents reduce vitreous volume and control intraocular pressure (IOP).

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Acetazolamide sodium (Diamox, Diamox sequels)

Inhibits enzyme carbonic anhydrase, reducing rate of aqueous humor formation, which, in turn, reduces IOP. Used for adjunctive treatment of chronic simple (open-angle) glaucoma and secondary glaucoma and preoperatively in acute angle-closure glaucoma when delay of surgery desired to lower IOP.

Class Summary

The exact mechanism of ocular antihypertensive action is not established, but it appears to be a reduction of aqueous humor production. However, some studies show a slight increase in outflow facility with timolol and metipranolol.

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Timolol maleate (Timoptic, Timoptic XE, Blocadren)

May reduce elevated and normal IOP, with or without glaucoma by reducing production of aqueous humor or by outflow. Available as 0.25% and 0.50% in aqueous and in gel for long action.

Class Summary

These agents are used to overcome pupillary block. Instillation of a long-acting cycloplegic agent can relax any ciliary muscle spasm that can cause a deep aching pain and photophobia.

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Atropine ophthalmic (Isopto Atropine, Atropisol)

Acts at parasympathetic sites in smooth muscle to block response of sphincter muscle of iris and muscle of ciliary body to acetylcholine, causing mydriasis and cycloplegia. Available as 0.5% and 1% ointment and solution.

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Contributor Information and Disclosures

Author

James V Aquavella, MD Professor of Ophthalmology, Department of Ophthalmology, University of Rochester School of Medicine, University of Rochester Eye Institute

James V Aquavella, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Medical Association, Contact Lens Association of Ophthalmologists, and International College of Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

Gregory J McCormick, MD Consulting Staff, Corneal and Refractive Surgery, Vermont Laser Vision at Timber Lane and Ophthalmic Consultants of Vermont

Gregory J McCormick, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, International Society of Refractive Surgery, and Medical Society of the State of New York

Disclosure: Nothing to disclose.

Specialty Editor Board

Bradford Shingleton, MD Assistant Clinical Professor of Ophthalmology, Harvard Medical School; Consulting Staff, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary

Bradford Shingleton, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Ophthalmology

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

J James Rowsey, MD Former Director of Corneal Services, St Luke's Cataract and Laser Institute, Florida

J James Rowsey, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for the Advancement of Science, American Medical Association, Association for Research in Vision and Ophthalmology, Florida Medical Association, Pan-American Association of Ophthalmology, Sigma Xi, and Southern Medical Association

Disclosure: Nothing to disclose.

Lance L Brown, OD, MD Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

References

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