Ocular Ischemic Syndrome Medication

Updated: Jun 10, 2019
  • Author: Tahira M Scholle, MD; Chief Editor: Andrew G Lee, MD  more...
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Medication

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and to prevent complications.

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Ophthalmic Steroids

Class Summary

Ophthalmic steroids are used to treat pain and anterior segment inflammation.

Prednisolone ophthalmic (Omnipred, Pred Forte, Pred Mild)

Prednisolone is used to treat acute inflammation following eye surgery or other insults to the eye. It decreases inflammation and corneal neovascularization, suppresses migration of polymorphonuclear leukocytes, and reverses increased capillary permeability.

Dexamethasone ophthalmic (Maxidex, Ozurdex)

Dexamethasone is used for various allergic and inflammatory diseases. It decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reducing capillary permeability.

Fluorometholone (Flarex, FML, FML Forte)

This agent suppresses the migration of polymorphonuclear leukocytes and reverses capillary permeability.

Triamcinolone intravitreal (Triesence, Trivaris Intravitreal)

Triamcinolone is used to treat inflammatory reactions that are responsive to steroids. It decreases inflammation by suppressing the migration of polymorphonuclear leukocytes and reversing capillary permeability. May be used intravitreally to treat cystoid macular edema.

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Cycloplegics

Class Summary

Cycloplegic drops are used to decrease pain and to stabilize the blood-aqueous barrier.

Atropine ophthalmic (IsoptoAtropine)

Atropine 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.

Cyclopentolate (Cyclogyl)

Cyclopentolate is the anticholinergic drug of choice in the treatment of cornea abrasions. It prevents the muscle of ciliary body and sphincter muscle of the iris from responding to cholinergic stimulation, causing mydriasis and cycloplegia.

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IOP-Lowering Medications

Class Summary

Glaucoma eyedrops such as beta-blockers, alpha-2 agonists, prostaglandin analogs, and carbonic anhydrase inhibitors are frequently used to control intraocular pressure.

Dorzolamide (Trusopt)

Dorzolamide is a reversible carbonic anhydrase inhibitor that may decrease aqueous humor secretion, causing a decrease in IOP. Presumably, it slows bicarbonate ion formation, producing a subsequent reduction in sodium and fluid transport. Systemic absorption can affect carbonic anhydrase in the kidney, reducing hydrogen ion secretion at the renal tubule and increasing renal excretion of sodium, potassium bicarbonate, and water. Dorzolamide is less stinging on instillation secondary to buffered pH.

Brinzolamide (Azopt)

Brinzolamide catalyzes a reversible reaction involving hydration of carbon dioxide and dehydration of carbonic acid. It may be used concomitantly with other topical ophthalmic drug products to lower IOP. If more than 1 topical ophthalmic drug is being used, administer them at least 10 minutes apart.

Brimonidine (Alphagan P)

Brimonidine is a relatively selective alpha2 adrenergic-receptor agonist that decreases IOP by dual mechanisms, reducing aqueous humor production and increasing uveoscleral outflow. Brimonidine has minimal effect on cardiovascular and pulmonary parameters. A moderate risk of allergic response to this drug exists. Caution should be used in individuals who have developed an allergy to Iopidine. IOP lowering of up to 27% has been reported.

Alphagan-P contains the preservative Purite and has been shown to be much better tolerated than its counterpart, Alphagan.

Apraclonidine (Iopidine)

Apraclonidine is a potent alpha adrenergic agent that is selective for alpha2 receptors, with minimal cross-reactivity with alpha1 receptors. It suppresses aqueous production and reduces elevated, as well as normal, IOP, whether accompanied by glaucoma or not. Apraclonidine does not have significant local anesthetic activity. It has minimal cardiovascular effects.

Latanoprost (Xalatan)

Latanoprost may decrease IOP by increasing the outflow of aqueous humor. Patients should be informed about possible cosmetic effects to the eye/eyelashes, especially if uniocular therapy is to be initiated.

Bimatoprost (Latisse, Lumigan)

This agent is a prostamide analogue with ocular hypotensive activity. It mimics the IOP-lowering activity of prostamides via the prostamide pathway. Bimatoprost ophthalmic solution is used to reduce IOP in open-angle glaucoma and ocular hypertension.

Travoprost ophthalmic (Travatan Z)

This agent is a prostaglandin F2-alpha analogue. It is a selective FP prostanoid receptor agonist that is believed to reduce IOP by increasing uveoscleral outflow. Travoprost ophthalmic solution is used to treat open-angle glaucoma and ocular hypertension.

Unoprostone ophthalmic (Rescula)

This agent is a prostaglandin F2-alpha analogue. It is a selective FP prostanoid receptor agonist that is believed to reduce IOP by increasing uveoscleral outflow. Unoprostone ophthalmic solution is used to treat open-angle glaucoma and ocular hypertension.

Tafluprost (Zioptan)

Tafluprost is a topical, preservative-free, ophthalmic prostaglandin analogue that is indicated for elevated IOP associated with open-angle glaucoma or ocular hypertension. The exact mechanism by which it reduces IOP is unknown, but it is thought to increase uveoscleral outflow.

Betaxolol ophthalmic (Betoptic, Betoptic S)

This agent selectively blocks beta1 adrenergic receptors, with little or no effect on beta2 receptors. It lowers IOP by reducing the production of aqueous humor. The drug may have less effect on the pulmonary system. Its IOP-lowering effect is slightly less than that of nonselective beta blockers. It may increase optic nerve perfusion and confer neuroprotection.

Carteolol ophthalmic

Carteolol has an intrinsic sympathomimetic activity (partial agonist activity), with possibly less adverse effect on cardiac and lipid profiles.

Timolol ophthalmic (Betimol, Istalol, Timoptic)

Timolol may reduce elevated and normal IOP, with or without glaucoma, by reducing the production of aqueous humor.

Levobunolol (Betagan)

Levobunolol is a nonselective beta adrenergic blocking agent that lowers IOP by reducing aqueous humor production and possibly increasing the outflow of aqueous humor.

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Intravitreal Anti-VEGF Medications

Class Summary

Anti-VEGF injections can be used to treat cystoid macular edema or to promote (temporary) regression of neovascularization.

Pegaptanib (Macugen)

This agent suppresses neovascularization and slows vision loss, resulting from macular degeneration, by binding to extracellular VEGF and selectively inhibiting VEGF from binding to its receptor.

Aflibercept intravitreal (Eylea)

Used in the treatment of macular edema. This agent inhibits the activation of endothelial cell receptors, thereby suppressing neovascularization, which can slow vision loss due to macular degeneration.

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