MYDRIATICS, CYCLOPLEGIC & ANTICHOLINERGIC MEDICATIONS

MYDRIATICS • used pre-op or for eye examinations to produce mydriasis

• dilate the pupils (mydriasis) • C/I in clients with glaucoma because of the risk of increased
CYCLOPLEGIA IOP
• relax the ciliary muscles • Mydriatics are C/I in cardiac dysrhythmias & cerebral
• atherosclerosis & should be used with caution in the elderly
and in clients with prostatic hypertrophy, diabetes mellitus or
parkinsonism

ANTICHOLINERGICS
block responses of the sphincter muscle in the ciliary SIDE EFFECTS
body, producing mydriasis ✓ Tachycardia
✓ Photophobia
✓ Conjunctivitis
✓ Dermatitis

EXAMPLES
• Atropine sulfate (Isopto-Atropine, Ocu-Tropine, Atropair, Atropisol)
• Scopolamine hydrobromide (Isopto-Hyoscine)
• Cyclopentolate hydrochloride (Cyclogyl, AK-Pentolate, Pentolair)
• Homotropine hydrobromide (Isopto Homatrine, AK-Homatropine,
Spectro-Homatrine)
• Tropicamide (Mydriacyl, I-Picamide, Tropicacyl)
• Phenylephrine hydrochloride (AK-Dilate, Dilatair, Mydfrin, Ocu-Phrin)

ATROPINE TOXICITY SYSTEMIC REACTIONS OF ANTICHOLINERGICS

✓ Dry mouth ✓ Dry mouth & skin

✓ Blurred vision ✓ Fever
✓ Photophobia ✓ Thirst
✓ Tachycardia ✓ Confusion
✓ Fever ✓ Hyperactivity
✓ Urinary retention
✓ Constipation
✓ Headache, brow pain
✓ Confusion
✓ Hallucinations, delirium
✓ Coma
✓ Worsening of narrow-angled glaucoma

ALPHA-ADRENERGIC BLOCKER

✓ example Dapiprazole hydrochoride (Rev-Eyes)

✓ used to counteract mydriasis

• Monitor for allergic reactions

• Assess for risk of injury
• Assess for constipation & urinary retention
• Instruct the client that a burning sensation may occur on installation
• Instruct the client not to drive or operate machine for 24 hrs after installation of the medication unless
otherwise directed by the physician
• Instruct the client to wear sunglasses until the effects of the medication wear off
• Instruct to notify MD if blurring of vision, loss of sight, difficulty in breathing, sweating or flushing occurs
• Instruct the client to report eye pain to the physician
 ANTI-INFECTIVE EYE MEDICATIONS

Kill or inhibit the growth of bacteria, fungi, & viruses SIDE EFFECTS
✓ Superinfection
✓ Global irritation

NURSING CARE
• Assess for risk of injury
• Instruct the client in how to apply the eye medication
• Instruct the client to continue treatment as Rx
• Instruct the client to wash hands thoroughly & frequently
• Advise the client that if improvement does not occur, notify the MD

ANTIBACTERIAL • Chloramphenicol (Chloromycetin, Chloroptic)

• Ciprofloxacin hydrochloride (Cipro)
• Erythromycin (Ilotycin)
• Gentamicin sulfate (Garamycin, Genoptic)
• Norfloxacin (Chibroxin)
• Tobramycin (Nebcin, Tobrex)
• Silver nitrate 1%

ANTIFUNGAL • Natamycin (Natacyn Opthalmic)

ANTIVIRAL • Idoxuridine (Herplex-Liquifilm)

• Trifluridine (Viroptic)
• Vidarabine (Vira-A Opthalmic)

ANTI-INFLAMMATORY EYE MEDICATIONS

Control inflammation, thereby reducing vision loss & SIDE EFFECTS

scarring ✓ Cataracts
Used for uveitis, allergic conditions, & inflammation of ✓ Increased IOP
the conjunctiva, cornea, & lids ✓ Impaired healing
✓ Masking S/S of infection

NURSING CARE
• Assess for risk of injury
• Instruct the client in how to apply the eye medication
• Instruct the client to continue treatment as Rx
• Instruct the client to wash hands thoroughly & frequently
• Advise the client that if improvement does not occur, notify the MD
• Note that dexamethasone (Maxidex) should not be used for eye abrasions & wounds

EXAMPLES
• Dexamethasone (Maxidex)
• Diclofenac (Voltaren)
• Flurbiprofen Na (Ocufen)
• Suprofen (Profenal)
• Ketorolac tromethamine (Acular)
• Prednisone acetate (Predforte, Econopred)
• Prednisolone Na phosphate (AK-Pred, Inflamase)
 TOPICAL ANESTHETICS FOR THE EYE

• Produce corneal anesthesia SIDE EFFECTS

• Used for anesthesia for eye examinations, for ✓ Temporary stinging or burning of the eye
surgery, or to remove foreign bodies from the ✓ Temporary loss of corneal reflex
eye

NURSING CARE
• Assess for risk of injury
• Note that the medications should not be given to the client for home use & are not to be self-
administered by the client
• Note that the blink reflex is temporarily lost & that the corneal epithelium needs to be protected
• Provide an eye patch to protect the eye from injury until the corneal reflex returns

EXAMPLES
• Proparacaine HCl (Ophthaine, Opthenic)
• Tetracaine HCl (Pontocaine)

EYE LUBRICANTS

•Replace tears or add moisture to the eyes SIDE EFFECTS

•Moisten contact lenses or an artificial eye ✓ Burning in installation
•Protect the eyes during surgery or diagnostic ✓ Discomfort or pain in installation
procedures
• Used for keratitis, during anesthesia or in a
disorder that results in unconsciousness or
decreased blinking
NURSING CARE
• Inform the client that burning may occur on installation
• Be alert to allergic responses to the preservatives in the lubricants

EXAMPLES
• Hydroxypropyl methylcellulose (Lacril, Isopto Plain)
• Petroleum-based ointment (Artificial Tears, Liquifilm

MIOTICS MIOTIC CHOLINERGIC MEDS

• reduce IOP by constricting the pupil & contracting reduce IOP by mimicking the action of acetylcholine
the ciliary muscle, thereby increasing the blood
flow to the retina & decreasing retinal damage &
loss of vision
• open the anterior chamber angle & increase the
outflow of aqueous humor
• used for chronic open-angle glaucoma or acute &
chronic closed-angle glaucoma
• used to achieve miosis during eye surgery
• C/I in clients with retinal detachment, adhesions
between the iris & lens, or inflammatory diseases
• used with caution in clients with asthma,
hypertension, corneal abrasion,hyperthyroidism,
coronary vascular disease, urinary tract
obstruction, GI obstruction, ulcer disease,
parkinsonism, or bradycardia
 MIOTIC ACETYLCHOLINE INHIBITORS MEDS

reduce IOP by inhibiting the action of cholinesterase SIDE EFFECTS

✓ Myopia
✓ Headache
✓ Eye pain
✓ Decreased vision in poor light
✓ Local irritation

EXAMPLES
• Acethylcholine Cl (Miochol)
• Carbachol (Miostat)
• Pilocarpine HCl (Isopto Carpine, Pilocar)
• Pilocarpine nitrate (Pilofrin, Liquifilm, Pilagan)
• Echothiophate iodide (Phospholine iodide)
• Demecarium bromide (Humorsol)
• Isoflurophate (Floropryl)

SYSTEMIC EFFECTS TOXICITY

✓ Flushing ✓ Vertigo & syncope

✓ Diaphoresis ✓ Bradycardia
✓ GI upset & diarrhea ✓ Hypotension
✓ Frequent urination ✓ Cardiac dysrhythmias
✓ Increased salivation ✓ Tremors
✓ Muscle weakness ✓ Seizures
✓ Respiratory difficulty

NURSING CARE
• Assess V/S & risk of injury
• Assess the client for the degree of diminished vision
• Monitor S/E & toxic effects
• Monitor for postural hypotension & instruct the client to change positions slowly
• Assess breath sounds for rales & rhonchi (cholinergic meds cause bronchospasms & increased
bronchial secretions )
• Maintain oral hygiene ( due to increased salivation)
• Have Atropine sulfate available as antidote for Pilocarpine
• Instruct the client regarding the correct administration of eye meds
• Instruct the client not to stop the meds suddenly
• Instruct to avoid activities such as driving while vision is impaired
• Instruct clients with glaucoma to read labels on OTC meds & to avoid Atropine-like medsm ( Atropine
increase IOP)

BETA-ADRENERGIC BLOCKING EYE MEDICATIONS

• Reduce IOP by decreasing sympathetic impulses & SIDE EFFECTS

decreasing aqueous humor production without ✓ Ocular irritation
affecting accommodation or pupil size ✓ Visual disturbances
• Used to treat chronic open-angle glaucoma ✓ Bradycardia
• C/I in the client with asthma ✓ Hypotension
• systemic absorption can cause increased airway ✓ Bronchospasm
resistance
• Used with caution in the client receiving oral beta-
blockers

NURSING CARE
• Monitor V/S before administering medication esp. BP & PR
• If the pulse is below 60 or if systolic BP is below 90 mm Hg, withhold the medication & contact MD
• Monitor for shortness of breath and I&O
• Assess for risk of injury
• Instruct the client to notify MD if shortness of breath occurs
 • Instruct not to D/C medication abruptly
• Instruct to change positions slowly to avoid orthostatic hypotension
• Instruct to avoid hazardous activities
• Instruct to avoid OTC meds without the MD’s approval

EXAMPLES
• Betaxolol HCl (Betoptic)
• Carteolol HCl (Ocupress)
• Levobunolol HCl (Betagan)
• Metipranolol (Optipranolol)
• Timolol maleate (Timoptic

ADRENERGIC EYE MEDICATIONS CARBONIC ANHYDRASE MEDICATIONS

• Decrease the production of aqueous humor & lead • Interfere with the production of carbonic acid
to a decrease in IOP which leads to decreased aqueous humor
• Used to treat glaucoma formation & decreased IOP
• Used for long-term treatment of open-angle
glaucoma
• C/I in the client allergic to sulfonamides

• Apraclonidine HCl (Iopidine)

• Brimonidine tartrate (Alphagen)
• Dipivefrin HCl (Propine)
• Epinephrine borate (Epinal, Eppy)
• Epinephrine HCl (Epifrin, Glaucon)

SIDE EFFECTS
✓ Appetite loss
✓ GI upset
✓ Paresthesias in the fingers, toes & face
✓ Polyuria
✓ Hypokalemia
✓ Renal calculi
✓ Photosensitivity
✓ Lethargy & drowsiness
✓ Depression

NURSING CARE
• Monitor V/S
• Assess visual acuity
• Assess for risk of injury
• Monitor I&O
• Monitor weight
• Maintain oral hygiene
• Monitor for side effects such as lethargy, anorexia, drowsiness, polyuria, nausea, & vomiting
• Monitor electrolytes for hypokalemia
• Increase fluid intake unless C/I
• Advise the client to avoid prolonged exposure to sunlight
• Encourage the client to use artificial tears for dry eyes
• Instruct not to D/C the medication abruptly
• Instruct to avoid hazardous activities while vision is impaired
 OSMOTIC MEDICATIONS

• Lower IOP SIDE EFFECTS

• Used in emergency treatment of acute closed- ✓ Nausea, vomiting, diarrhea
angle glaucoma ✓ Disorientation
• Used pre-op & post-op to decrease vitreous humor ✓ Electrolyte imbalance
volume ✓ Headache

NURSING CARE
• Assess V/S, visual acuity & risk for injury
• Monitor weight and I&O
• Monitor electrolytes
• Increase fluid intake unless C/I
• Monitor for changes in level of orientation

EXAMPLES
• Glycerin (Glyrol, Osmoglyn)
• Mannitol (Osmitrol)
• Urea (Ureaphil)