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Related Concept Videos

Ophthalmic Drug Delivery Systems01:23

Ophthalmic Drug Delivery Systems

Ophthalmic drug delivery faces major limitations due to poor absorption across the corneal membrane. This process is primarily driven by diffusion and is influenced by two main factors: the physicochemical properties of the drug and tear drainage. Most ophthalmic drugs, such as pilocarpine, epinephrine, atropine, and local anesthetics, are weak bases. They are typically formulated at an acidic pH to enhance chemical stability. However, this leads to high ionization, reducing their ability to...
Angle Closure Glaucoma: Treatment01:28

Angle Closure Glaucoma: Treatment

Angle-closure glaucoma, or closed-angle glaucoma, is an eye condition where the iris bulges out and blocks the iridocorneal angle, resulting in a buildup of aqueous humor and increased intraocular pressure. Immediate medical attention is necessary due to the sudden onset of symptoms. The treatment for angle-closure glaucoma includes short-term and long-term approaches. Short-term treatment involves using eye drops like pilocarpine to lower intraocular pressure by increasing aqueous humor...
Open Angle Glaucoma: Treatment01:27

Open Angle Glaucoma: Treatment

In open-angle glaucoma, the iridocorneal angle remains open, but the trabecular meshwork becomes stiff, slowing down the outflow of aqueous humor. This causes a buildup of aqueous humor in the anterior chamber, leading to a sudden increase in intraocular pressure. The treatment for open-angle glaucoma focuses on reducing the elevated intraocular pressure by either decreasing the secretion of aqueous humor or increasing its outflow.
Drugs such as carbonic anhydrase inhibitors, α2- and...
Glaucoma: Overview01:25

Glaucoma: Overview

Glaucoma is an eye condition characterized by increased intraocular pressure that damages the retina and optic nerve, leading to irreversible blindness if left untreated. The human eye has various components, including the cornea, iris, pupil, lens, and optic nerve. Aqueous humor is secreted by the epithelium of the ciliary body in the posterior chamber and flows through the trabecular meshwork and canal of Schlemm, maintaining normal intraocular pressure. The trabecular meshwork and the canal...
Adrenergic Agonists: Therapeutic Uses01:30

Adrenergic Agonists: Therapeutic Uses

Adrenergic agonists have diverse therapeutic uses across various medical conditions and emergencies.
Emergency and Intensive Care Unit (ICU) applications: Pressor agents increase blood pressure, heart rate, and contractility in shock and organ failure situations. Dopamine can induce vasodilation and stimulate adrenoceptors. Endogenous catecholamines are effective in treating cardiogenic shock. α2-agonists like clonidine can reverse anesthesia-induced hypertension.
Allergies and anaphylaxis:...
Adrenergic Agonists: Mixed-Action Agents01:28

Adrenergic Agonists: Mixed-Action Agents

Mixed-action adrenergic agonists, like ephedrine and pseudoephedrine, directly and indirectly affect adrenergic receptors. These agents stimulate adrenoceptors and indirectly release stored neurotransmitters, amplifying the adrenergic response.
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Use of Rabbit Eyes in Pharmacokinetic Studies of Intraocular Drugs
10:02

Use of Rabbit Eyes in Pharmacokinetic Studies of Intraocular Drugs

Published on: July 23, 2016

Ocular phenylephrine 2.5% continues to be dangerous.

Nauman Ahmed1, Waleed Riad, Abdullah Altorpaq

  • 1King Khaled Eye specialist Hospital, Anesthesia, P.O.Box 7191, Riyadh, 11462, Saudi Arabia.

BMJ Case Reports
|June 21, 2011
PubMed
Summary

Even diluted phenylephrine 2.5% eye drops can cause dangerous systemic reactions. This case highlights the unpredictable and severe cardiovascular effects of topical phenylephrine in ophthalmology.

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Area of Science:

  • Ophthalmology
  • Cardiology
  • Pharmacology

Background:

  • Phenylephrine is commonly used in ophthalmology for pupillary dilatation and capillary decongestion.
  • A lower concentration (2.5%) is generally recommended over 10% to minimize systemic absorption and adverse effects.

Purpose of the Study:

  • To report a case of severe systemic manifestation following conjunctival application of 2.5% phenylephrine.
  • To emphasize the potential dangers and unpredictable responses associated with phenylephrine use in ophthalmic procedures.

Main Methods:

  • A case report of a healthy adult undergoing pterygium excision.
  • Monitoring of vital signs before and after topical application of phenylephrine 2.5% to control bleeding.
  • Administration of emergency medications and diagnostic workup including ECG and myocardial infarction screening.

Main Results:

  • The patient experienced severe bradycardia and hypotension after phenylephrine application, requiring atropine.
  • Subsequent development of tachycardia, severe hypertension, and ischemic ECG changes.
  • Resolution of ischemic changes and negative myocardial infarction markers the following day.

Conclusions:

  • Topical phenylephrine 2.5% can cause significant and unpredictable systemic cardiovascular adverse events.
  • Ophthalmologists should remain vigilant regarding the potential risks of phenylephrine, even at lower concentrations.
  • Careful patient monitoring and preparedness for managing adverse reactions are crucial during ophthalmic procedures involving phenylephrine.