Page 155 - WSAVA2017
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Indications/effects: Useful for localizing lesions with Horner’s syndrome, mydriasis
augmentation in dogs
Contraindications/adverse effects: Can cause systemic vascoconstriction and cardiac arrhythmias
Parasympatholytic agents (atropine ophthalmic solution/ ointment, tropicamide ophthalmic solution)
Indications/effects: Mydriasis for short diagnostic purposes (tropicamide) or longer acting therapeutic (atropine) purposes, cycloplegia and pain relief (atropine), blood-aqueous barrier stabilization, prevent synechia formation
Contraindications/adverse effects: Can increase intraocular pressure (avoid in glaucoma patients), decreases tear production (atropine, avoid in dry eye patients), hypersalivation and occasional vomiting (atropine, cats)
Direct-acting parasympathomimetic agents (pilocarpine ophthalmic solution)
Indications/effects: To diagnose parasympathetic lesions, decreases IOP, neurogenic dry eye
Contraindications/adverse effects: Miosis, inflammatory, less potent than other drugs for glaucoma treatment, systemic adverse effects (salivation, vomiting, diarrhea, and abdominal cramps)
Indirect-acting parasympathomimetic agents (demecarium bromide compounded
ophthalmic solution)
Indications/effects: Glaucoma prophylaxis in dogs, infrequent administration
Contraindications/adverse effects: Miosis, less potent than other drugs for glaucoma treatment, irritation
Anti-glaucoma Drugs
Prostaglandin analogues (latanoprost, travoprost or bimatoprost ophthalmic solutions)
Indications/effects: Potent intraocular pressure (IOP) reduction
Contraindications/adverse effects: Contraindicated with anterior lens luxation, ineffective in cats and horses, mildly inflammatory, intense miosis
Carbonic anhydrase inhibitors (dorzolamide or brinzolamide ophthalmic solutions)
Indications/effects: IOP reduction. Effective in dogs, cats and horses
Contraindications/adverse effects: Less potent than prostaglandin analogues, local irritation
Beta-blockers (timolol or betaxolol ophthalmic solution)
An Urban Experience
Indications/effects: Decreases IOP in horses and cats, glaucoma prophylaxis in dogs
Contraindications/adverse effects: Bradycardia, less potent than other drugs for glaucoma (dogs), avoid in patients with respiratory or cardiac disease
Anti-inflammatory Drugs
Corticosteroids (dexamethasone sodium phosphate 0.1%, prednisolone acetate 1%)
Indications/effects: Potent treatment of anterior segment inflammatory or suspected immune-mediated disease, decreases corneal vascularization and melanosis. Acetates and alcohols are lipophilic and have good corneal penetration (i.e. can be used to treat of anterior uveitis), sodium phosphates have poorer corneal penetration.
Contraindications/adverse effects: Delays corneal wound healing, increases risk of infection and should be avoided with corneal ulceration or infection, can induce ocular feline herpes virus 1 reactivation in cats, may induce and/or exacerbate lipid +/- mineral degeneration of the cornea (steroid keratopathy) with chronic use, combination formulations with antibiotics should be avoided for chronic use to reduce risk of development of bacterial resistance, frequent/long-term administration may disrupt diabetes mellitus management or cause reversible adrenocortical suppression
Non-steroidal Anti-Inflammatory Drugs (flurbiprofen, diclofenac, nepafenac)
Indications/effects: Good anti-inflammatory choice for diabetic patients, less likely to inhibit corneal healing than corticosteroids, potent
Contraindications/adverse effects: Less potent anti- inflammatory than corticosteroids, can increase IOP, associated with corneal melting in humans
Immunosuppressant drugs
Calcineurin-inhibitors (cyclosporine, tacrolimus, pimecrolimus)
Indications/effects: Keratoconjunctivitis sicca
(KCS), chronic superficial keratitis, eosinophilic keratoconjunctivitis and other immune-mediated
surface diseases, decreases corneal vascularization and melanosis. Tacrolimus and pimecrolimus may be effective in KCS cases where cyclosporine is ineffective
Contraindications/adverse effects/disadvantages:
Poor intraocular penetration (ineffective for uveitis), irritation, besides Optimmune (cyclosporine 0.2%) these medications must be compounded, concerns about carcinogenic potential

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