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Eye

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((Anatomy))

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Iris sphincter Iris dilator

Parasympathetic

innervations

Sympathetic

innervations

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The iris is the most anterior portion of the uveal tract.

The anterior surface of the iris is the stroma, a loosely

organized structure containing melanocytes, blood

vessels, smooth muscle, and parasympathetic and

sympathetic nerves. The posterior surface of the iris is

a densely pigmented bilayer of epithelial cells.Anterior to the pigmented epithelium, the dilator

smooth muscle is oriented radially and is innervated

by the sympathetic nervous system which causes

mydriasis (dilation). At the pupillary margin, thesphincter smooth muscle is organized in a circular

band with parasympathetic innervation, which when

stimulated causes miosis (constriction).

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OrganSympathetic

effect

Adrenergic

receptor type

Parasympathetic

effect

Cholinergic

receptor type

Iris

Dilatation of

Dilator muscle

(mydriasis)

Constriction of

Sphincter muscle

(myosis)

M3

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Mydriasis

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Mydriasis is the widening of eye pupil. this occurs

normally in dim light. Persistent mydriasis occurs

due to certain drugs such as adrenalin, atropine .

In addition, eye injury may be a common cause

Definition:

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MydriaticsA- Parasympathetic antagonist:

1) Atropine 0.5 or 1% eye drop.Properties: competitive direct-acting antimuscarinic blocker.Indication: uveitis, iritis, strabismus, mydriasis for ophthalmic

examination (refraction) and surgery.

Adverse effects:Locally: local irritation, hyperaemia, oedema, and

conjunctivitis, loss of accommodation (cycloplegia) and

photophobia. An increase in intra-ocular pressuremay occur,

especially in patients with angle-closure glaucoma.Peripheral effects: drymouth, thirst, reduced bronchial

secretions, flushing and skin, transient bradycardia followed

by tachycardia, palpitations and arrhythmias, and

constipation, hypersensitivity.

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2) Cyclopentolate.Properties: As atropine ,but Rapid onsetand shorter

duration than atropine.

Indication: uveitis ,iritis, strabismus, mydriasis forophthalmic examination.

Adverse effects: As for atropines sulfate. Eye drops ofcyclopentolate hydrochloridemay cause temporary

irritation.3)Homatropine.

4)Tropicamide.

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Sympathetic agonist

1)Phenylephrine 0.12

% to2

.5% or 10%.Properties: a sympathomimetic has mainly alpha-agonisteffect.

Indication: conjunctival decongestant (0.12%), mydriasis

for ophthalmic examination and surgery.

Adverse effects: Corneal clouding may occur if cornealepithelium has been denuded or damaged.

contra-indicated in patients with angle-closure glaucoma.2) Hydroxyamfetamine1%: is used in somecountries as a mydriatic agent and in the diagnosis of

Horner's syndrome.

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Action Organs involved drugs

mydriasis

Sympathetic ParasympatheticSympathetic

agonist

Parasympathetic

blockers

Dilator muscle Sphincter muscle phenylephrine

Atropine,

cyclopentolate,

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Miosis

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Miosis is the constriction of eye pupil, this occurs

normally in bright light. Persistent miosis occurs due

to certain drugs such as (morphine, pilocarpine), also

drugs used mainly for treatment of glaucoma, also

it's related to some diseases such as (Horner'ssyndrome).

Definition:

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Miosis may cause blurred vision and difficulty with dark

adaptation. Caution is necessary at night driving or when

hazardous tasks are undertaken in poor illumination.

Miotics are contra-indicated whene miosis is undesirable

such as:

acute uveitis, anterior uveitis, and secondary glaucoma.

They should be avoided in acute inflammatory disease of

the anterior segment of eye .Used with extreme caution

in patients with a history of retinal detachment. Care isneeded in patients with corneal or conjunctival damage.

Miotics should not be used by patients wearing soft

contact lenses.

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Miotics

Pilocarpine 0.5 to 4% eye drops.

Properties:direct-acting muscarinic agonist

Indication:glaucoma , dry eye

Adverse effects:ciliary spasm, ocular pain and irritation,

blurred vision, lachrymation, myopia, and

browache. Conjunctival vascular congestion,superficial keratitis, vitreous haemorrhage.

should be avoided after drainage operations

for glaucoma.

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Carbachol 0.01% eye drops.

Properties: A cholinergic agonist has a doubleaction, stimulates cholinergic receptors, also

partially inhibits cholinesterase.

Indication:glaucoma.

Adverse effects: ciliary spasm, corneal

oedema, clouding, and

decompensation, persistent bullous

keratopathy, retinal detachment, and

postoperative iritis.

Echothiophate 0.03 to 0.2

5% eye drops.

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Action Organs involved Drugs

Miosis

Sympathetic ParasympatheticSympathetic

blockers

Parasympathetic

agonist

Dilator muscle Sphincter muscle - Pilocarpine,acetylcholine

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Eye disorders

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It includes: Inflammation, Allergic reaction,

Trauma, Abrasion, infection (keratitis Uveitis-

iritis ) occurs most frequently, also the orbit,eyelids, lachrymal sacs, conjunctiva(Trachoma),

sclera, and intra-ocular structures may become

infected by various microorganisms.Treatment

Treatment ofeye disorders implies theuse of:

Antimicrobial agents (antibacterial, antifungal, and

antiviral agents).

Anti-inflammatory agents (Corticosteroids and

Nonsteroidal anti-inflammatory drugs (NSAIDs)).

Local anesthetics.

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Inflammation

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Inflammation:-The bodys response to injury which may be acute or

chronic.Acute inflammation is the immediate defensive reaction

of tissue to any injury, which may be caused by

infection, chemicals, physical agents.

It includes: pain, heat, redness, swelling , and loss offunction of the affected part.

Blood vessels are dilated so the blood flow is increased.

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Anti-inflammatory agent

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Corticosteroids:

Glucocorticoid actions are wide-ranging. They have

potent anti-inflammatory and immunosuppressiveeffects, through inhibition of the release of various

cytokines .topical corticosteroids areused in ocular

allergy, inflammation associated with infections,and following ocular surgery.

However, its use should be restricted to severe

cases only and limited to 5 to 7 days' duration

because of the risk of local adverseeffects such as

delay wound healing and mask postoperative

infection.

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Prednisolone 0.5-1% drops

Properties: synthetic glucocorticoidIndication: allergic conjunctivitis; allergic

corneal ulcers; chorioretinitis; uveitis and

choroiditis; optic neuritis.

Adverse effects: glaucoma with optic

nerve damage, visual defects, cataract,

secondary ocular infections, raised intra-

ocular pressure

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Nonsteroidal antiinflammatory drugs

(NSAIDs):

Diclofenac sodium 0.1%Properties: is a sterile, topical, nonsteroidal, anti-

inflammatory product for ophthalmic use.

Indication: postoperative inflammation of cataract

extraction.

Adverse effects: Local irritation.

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Antimicrobials

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A number of antimicrobials (antibacterial, antifungal, and

antiviral) agents have been formulated for topical ocular use

Chloramphenicol 0.5% eye drops.

ciprofloxacin 0.3% eye drops.

ofloxacin 0.3%, eye drops.

fusidic acid 1% drops in a gel basis.

aciclovir 3% eye ointment.

ganciclovir 0.15% in gel basis.gentamicin 0.3% eye drops.

neomycin 0.5% eye drops.

lomefloxacin 0.3% eye drops.

propamidine isetionate (Brolene) 0.1% eye drops.

dibromopropamidine isetionate 0.15% ointment. Neomycin with Polymyxin B before ophthalmic surgery for

prophylaxis.

povidone-iodine 1.25% eye drop.

tetracycline 1% topical ointment.

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Local anesthetics

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IT

is used for ocular surgery deep orsuperfacial.

Topical anesthetic agents used clinically in

ophthalmology include:Bupivacaine 0.5%.

Oxybuprocaine 0.4% to 1%.

Tetracaine 0.5 to 1% drops.

Proxymetacaine 0.5%.

Lidocaine 1% or jelly 2%.

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Lidocaine and bupivacaine areused for

infiltration and retrobulbar block

anesthesia for surgery.

Proxymetacaine and tetracaine areused

topically to perform tonometry, to remove

foreign bodies on the conjunctiva and

cornea, to perform superficial corneal

surgery, and to manipulate thenasolacrimal canalicular system. They also

used topically to anesthetize the ocular

surface for refractive surgery.

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Adverseeffects:

Prolonged use of topical anaesthetics in theeye

causes corneal damage.The systemic toxicity of local anaesthetics

mainly involves the CNS and the cardiovascular

system. Excitation of the CNS manifested byrestlessness, excitement, nervousness,

dizziness, blurred vision, nausea and vomiting,

muscle twitching and tremors, and convulsions.Excitation may be transient followed by

depression with drowsiness, respiratory failure,

and coma.

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Man becomes what he thinks

about

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Name:

1-Abdullah Al-mazhari

2-Fouad Mohammed

Busily

3-Khaldon Ali Salem

4-Mahmood Al-qtibie

5-Mohammed ismael

6-Ebrahim Noaman

Thanks for

Dr-Nabil

Al-Baser