Phacoanaphylaxis Medication

Updated: Jun 10, 2021
  • Author: Robert H Graham, MD; Chief Editor: John D Sheppard, Jr, MD, MMSc  more...
  • Print
Medication

Medication Summary

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

Next:

Cycloplegics

Class Summary

Cyclopentolate, atropine sulfate, homatropine, and scopolamine break or prevent formation of posterior synechiae; stabilize the blood-aqueous barrier, leading to reduced leakage of plasma proteins; increase uveoscleral outflow; and provide mild relief of ciliary spasm pain. The stronger the inflammatory reaction, the more frequently applied or stronger the cycloplegic.

Cyclopentolate hydrochloride 0.5%, 1%, 2% (Cyclogyl, AK-Pentolate, I-Pentolate)

Blocks muscle of ciliary body and sphincter muscle of iris from responding to cholinergic stimulation, thus causing mydriasis and cycloplegia.

Previous
Next:

Corticosteroids

Class Summary

Block formation of arachidonic acid from cell membrane precursors by inhibiting action of phospholipase-A2. Corticosteroids frequently are used in uveitis therapy. Topical corticosteroids are given in dosages ranging from once daily to hourly. They also can be given in an ointment form. Periocular corticosteroids generally are given as depot-steroid injections when a more prolonged effect is needed or when a patient is noncompliant or poorly responsive to topical administration.

Prednisolone ophthalmic (AK-Pred, Econopred Plus, Pred Forte)

Treats acute inflammations following eye surgery or other types of insults to eye.

Decreases inflammation and corneal neovascularization. Suppresses migration of polymorphonuclear leukocytes and reverses increased capillary permeability.

In cases of bacterial infections, concomitant use of anti-infective agents is mandatory; if signs and symptoms do not improve after 2 days, reevaluate patient. Dosing may be reduced, but advise patients not to discontinue therapy prematurely.

Previous
Next:

Nonsteroidal anti-inflammatory agents (NSAIDs)

Class Summary

Inhibit cyclooxygenase pathway that controls prostaglandin biosynthesis. NSAIDs have both topical analgesic and anti-inflammatory effects. Although NSAIDs currently do not have a significant role in uveitis therapy beyond the treatment of macular edema, they may have a synergistic effect with topical corticosteroids, and, because of minimal adverse effects, they often are used in cases of intraocular inflammation.

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 decreases vascular permeability.

Previous
Next:

Beta-adrenergic blocking agents

Class Summary

Decrease production of aqueous humor by the ciliary epithelium, resulting in decreased intraocular pressure. Beta-blockers reduce aqueous formation by 24-48%.

Timolol maleate 0.25-0.5% (Timoptic, Betimol)

Ocular hypotensive medication that lowers intraocular pressure by reducing aqueous humor production. Reduces cardiac output, decreases heart rate and blood pressure, produces beta-adrenergic receptor blockade in bronchi and bronchioli, and has little or no effect on pupil size and accommodation.

Previous
Next:

Alpha2-adrenergic agonists

Class Summary

Potent inhibitors of aqueous production, reducing it by 35-40%.

Brimonidine (Alphagan P)

Relatively selective alpha2-adrenergic agonist. Has dual mechanism of action by reducing aqueous humor production and increasing uveoscleral outflow.

Previous
Next:

Carbonic anhydrase inhibitors

Class Summary

These agents are nonbacteriostatic sulfonamides that inhibit enzyme carbonic anhydrase (eg, topical dorzolamide, brinzolamide, systemic methazolamide, acetazolamide). This action reduces the rate of aqueous humor production, resulting in decreased intraocular pressure.

Dorzolamide (Trusopt)

Formulated for topical ophthalmic use. Inhibition of carbonic anhydrase in ciliary processes decreases aqueous humor secretion, presumably by slowing the formation of bicarbonate ions with subsequent reduction in sodium and fluid transport. The result is decreased intraocular pressure.

Acetazolamide (Diamox, Diamox Sequels)

Used for adjunctive treatment of glaucoma. Reduces aqueous humor formation by 20-40% with no significant change in outflow facility. Approximately 90% is bound to plasma proteins and excreted by urine largely unmetabolized. Maximal effect is noted 2-4 h after oral administration and 10-15 min after IV administration.

Previous