Postoperative Flat Anterior Chamber Medication

Updated: Apr 12, 2019
  • Author: Andrew A Dahl, MD, FACS; Chief Editor: Hampton Roy, Sr, MD  more...
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Medication

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.

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Osmotic diuretics

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.

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.

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Carbonic anhydrase inhibitors

Class Summary

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

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.

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Beta-blockers

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.

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.

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Cycloplegics and mydriatics

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.

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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