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 or eyes with shallow anterior chambers. Broad-spectrum antibiotics are appropriate with wound leaks and in recent surgery or trauma cases.
Corticosteroids, Ophthalmic
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 ophthalmic (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. The 1% ophthalmic is recommended.
Difluprednate (Durezol)
Ophthalmic corticosteroid indicated for inflammation and pain associated with ocular surgery. Available as a 0.05% ophthalmic emulsion.
Ophthalmic NSAIDs
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.
Ketorolac ophthalmic (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. The 0.5% ophthalmic is recommended.
Nepafenac ophthalmic (Nevanac)
Nonsteroidal anti-inflammatory prodrug for ophthalmic use. Following administration, converted by ocular tissue hydrolases to amfenac, an NSAID. Inhibits prostaglandin H synthase (cyclooxygenase), an enzyme required for prostaglandin production. Indicated for treatment of pain and inflammation associated with cataract surgery.
Bromfenac ophthalmic (Xibrom, Bromday)
Nonsteroidal anti-inflammatory drug for ophthalmic use. Blocks prostaglandin synthesis by inhibiting cyclooxygenase 1 and 2. Indicated to treat postoperative inflammation and reduce ocular pain after cataract extraction.
Cycloplegics/Mydriatics
Class Summary
These agents relax any ciliary muscle spasm that can cause a deep aching pain and photophobia.
Atropine ophthalmic (IsoptoAtropine)
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.
Tetracyclines
Class Summary
These agents provide broad-spectrum bacteriostatic antibiotic coverage.
Doxycycline (Vibramycin, Monodox)
Inhibits protein synthesis and, thus, bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria. May block dissociation of peptidyl t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest.
Fluoroquinolones
Class Summary
Topical fluoroquinolones provide well-tolerated broad-spectrum coverage in cases of wound leak or during the immediate postoperative recovery period.
Moxifloxacin ophthalmic (Moxeza, Vigamox)
Inhibits topoisomerases II and IV, which prevents appropriate repair, replication, and transcription of bacterial DNA.
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Seidel-positive wound leak around a conjunctival suture.
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Conjunctival advancement flap sewn over a diffusely incompetent bleb.
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Eroded tube shunt in a patient with rheumatoid arthritis.
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Flat anterior chamber with iris-corneal touch following a phacotrabeculectomy.
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Autologous blood injected into an overfiltering bleb to create a blood patch.
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B-scan ultrasound of choroidal effusions before and after surgical drainage.
