Medication Summary
Topical anti-inflammatory agents, especially prednisolone acetate 1%, are indicated in all types of hypotony. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be used adjunctively. Cycloplegic agents are often indicated in swollen eyes. Topical broad-spectrum antibiotics are appropriate with wound leaks and in recent surgery or trauma cases.
Corticosteroids
Class Summary
These agents have anti-inflammatory properties and cause profound and varied metabolic effects. Corticosteroids modify the body's immune response to diverse stimuli.
Prednisolone acetate 1% (Pred Forte)
A glucocorticoid that inhibits edema, fibrin deposition, capillary dilation, and phagocytic response of acute inflammation. Also inhibits capillary proliferation, collagen deposition, and scar formation. Corneal penetration is good.
Mydriatics/Cycloplegics
Class Summary
These agents relax any ciliary muscle spasm that can cause a deep aching pain and photophobia.
Atropine ophthalmic (Isopto, Atropair)
Potent and long-acting agent that produces paralysis of accommodation (cycloplegia) and pupillary dilation (mydriasis). In uveitis, cycloplegics relax the intraocular muscles, decreasing pain and photophobia. Reduce abnormal vascular permeability, and dilate the pupil.
Nonsteroidal anti-inflammatory agents
Class Summary
These agents have analgesic and anti-inflammatory actions. Their mechanism of action is not known but may inhibit cyclooxygenase activity and prostaglandin synthesis. Other mechanisms may also occur, such as inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell membrane functions.
Diclofenac ophthalmic (Voltaren)
Inhibits prostaglandin synthesis by decreasing activity of enzyme cyclooxygenase, which, in turn, decreases formation of prostaglandin precursors. May facilitate outflow of aqueous humor and decrease vascular permeability.
Ketorolac 0.5% (Acular)
Inhibits prostaglandin synthesis by decreasing activity of the enzyme, cyclooxygenase, which results in decreased formation of prostaglandin precursors, which, in turn, results in reduced inflammation.
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