Medicamentos oftalmicos

A Supplement to
Y = .667

June 15, 2006

Sponsored by by Ron Melton, O.D., and Randall Thomas, O.D.

INTRODUCTION
Dear Friends, We have now been in practice 25 years and continue to find great satisfaction in caring for our patients. Our fine profession continues to mature beautifully. Improved high index materials, silicone hydrogel lenses, advanced diagnostic technologies, and ahandsome armamentarium of ophthalmic medicines continue to create excitement and enthusiasm in optometric care. Like a child’s playroom littered with an abundance of toys, we too have an abundance of drugs from which to choose. Most just lay around, but a select few are engaged regularly. The truth is, we usually only need a handful of drugs to meet the clinical needs of our patients: an antibiotic; asteroid; a combination antibiotic-steroid; an NSAID; an antiviral; an artificial tear; and a prostaglandin. With seven drugs, you’re “golden” probably 95% of the time. Hopefully, this drug guide will help you fully appreciate these seven drug classes as well as their applications. Last year, we shared the news that Livostin and Rescula were no longer with us. This year, the obituary is forOsmoglyn. In cases of acute angle closure in sulfa-allergic patients, this might pose a bit of a challenge. The full details are inside. (See page 17.) We long for the days of real pharmaceutical breakthroughs. The beta-blockers that arrived in 1978 and the prostaglandins in 1996 were exciting innovations that significantly advanced patient care, and while there is no such groundbreaking news this year,it is only a matter of time. There are two new topical NSAIDs, and they will be discussed in their chapter. The good news is we do have an abundance of excellent drugs that nicely meet the needs of our patients. Please reference our website, www.eyeupdate.com, for further drug information not contained in this 2006 Clinical Guide to Ophthalmic Drugs. Thanks to all of you who so graciouslycompliment this work each year. We are in turn grateful to Bausch & Lomb Pharmaceuticals and Review of Optometry for making this resource available to the optometric profession. Our very best wishes to each of you. Sincerely,

Sponsored by

CONTENTS

Antibiotics . . . . . . . . . . . . . . 2A

A New Look at NSAIDs . . . . . . . . . . . . . . . . . 8A

Glaucoma . . . . . . . . . . . . . . 12ACorticosteroids . . . . . . . . . 20A

Antiviral Drugs . . . . . . . . . 26A
Randall Thomas, O.D., M.P.H. Ron Melton, O.D.

Allergy Drugs . . . . . . . . . . . 30A

Countering the Dysfunctional Tear Film . . . . . . . . . . . . . . 36A

Diagnosis and Treatment of Fungal Infection . . . . . . . . 43A

Clinical Pearls in Patient Care . . . . . . . . . . . . 46A

REVIEW OF OPTOMETRY JUNE15, 2006

1A

ANTIBIOTICS
Red eyes are either infectious or inflammatory, and inflammation is by far the more common presentation. That said, antibiotics are necessary to treat microbial keratitis.

W

hile antibiotics are often lifesaving in hospital settings, topical antibiotics can be sight-saving in rare circumstances, and usually under the care of corneal specialists. In theseclinical circumstances, the ability of the antibiotic to aggressively kill bacteria is essential. However, for the most part, topical antibiotics are used in a preventive or prophylactic manner in primary eye care. The prophylactic use of antibiotics can be important if there is significant corneal epithelial compromise, but if the cornea is pristine, the need for prophylaxis is minimal to nil.Bacterial infections are not uncommon in children, but they are uncommon in adults. In fact, if you are contemplating penning an antibiotic prescription for an adult, we strongly urge you to carefully rethink that decision. The epidemiological reality is that almost all keratoconjunctivitides in adults are the result of inflammation, and either a steroid or a steroid-antibiotic combination is almost...