Eye Drops

The role of eye drops in glaucoma treatment

Glaucoma is a severe disease characterized by a continuous or periodic increase in intraocular pressure (IOP). In this case, eye drops act not just as a symptomatic remedy, but as the main therapeutic tool. The main goal of their use is a reliable reduction in intraocular pressure.

Pharmacological strategies in this context come down to two main mechanisms: drugs either purposefully reduce the production of intraocular fluid or actively increase its outflow pathways. Using drops specifically, rather than tablets or subconjunctival injections, helps minimize the risk of systemic toxicity.

Antimicrobial drops and solutions

Antibacterial agents are widely used to combat infectious eye conditions such as conjunctivitis, blepharitis, keratitis, and trachoma. A prominent representative is sulfamethoxypyridazine, which is available in the form of eye drops and special eye films. In addition to ophthalmology, solutions of this drug are in demand in surgical practice for irrigation, inhalation, and introduction into purulent wound cavities.

Preparations from other groups (e.g., nitrofuran derivatives) are also used in the form of aqueous solutions and drops. They are effective for conjunctivitis and are also suitable for washing wounds, mucous membranes, serous and joint cavities. An important feature of such solutions is that they do not irritate tissues at all and additionally stimulate regeneration and healing processes. By comparison, for purulent-inflammatory skin lesions, ointments (e.g., Chinifuryl) are preferred over drops.

Diagnosis and therapy of allergic conjunctivitis

Allergic reactions affecting the eyes require an integrated approach. The diagnosis of long-standing inflammatory processes necessarily includes analysis of a conjunctival scraping: the detection of eosinophils or basophils in it serves as a clear marker of allergy.

General treatment principles are based on three methods: prevention of contact with the allergen, drug therapy, and immunotherapy. Local drug support includes several groups of eye drops:

• Antihistamines (Spersallerg, Polinadim). They are prescribed according to a strict regimen: the first 3 days, one drop 3 times a day, then the dosage is reduced to 2 times a day. The total course is 2 weeks.
• Mast cell stabilizers (cromoglicic acid preparations).
• Combination agents (containing 0.1% olopatadine and 0.025% ketotifen). They are instilled 1 drop 2 times a day as a long-term course — from 3 weeks to 3 months.

In severe cases, topical therapy is enhanced with drops of 0.1% dexamethasone or 0.1% diclofenac (3 times a day). Additionally, systemic antihistamines are prescribed orally for 10 days (Tavegil, Suprastin).

Immunotherapy and prevention

The baseline, most effective, and safest prevention method remains complete elimination of contact with the allergen. However, in pollinosis conjunctivitis, this is not always possible.

If contact with pollen is unavoidable, scheduled prevention is performed: 2 weeks before the expected contact, the patient is prescribed cromoglicic acid or olopatadine drops (1–2 times a day), the use of which continues throughout the entire period in the risk zone. If the patient has already entered risk conditions, emergency prevention is used with Spersallerg or Polinadim drops. They provide an immediate effect that lasts for 12 hours.

In persistent recurrent cases, immunotherapy is indicated. Allergen-specific therapy is performed strictly in a medical facility during remission (proven efficacy is 96.6%). Nonspecific immunotherapy can be performed on an outpatient basis: the patient is prescribed the immunomodulator Lycopid orally at a dose of 1–10 mg/day for a 10-day course.

Drug-induced conjunctivitis

Paradoxically, eye drops themselves can provoke inflammation. Drug-induced conjunctivitis is defined as an inflammatory reaction of the conjunctiva of allergic or toxic genesis occurring in response to the use of medications. The epidemiology of this condition is unequivocal: more than 90% of all cases are a direct result of topical therapy, and only about 10% of cases develop as a side effect of systemic drug intake.

Class and exam questions

What else to study on this topic

• Mechanisms of lowering intraocular pressure: impact on fluid production and outflow
• Pharmacodynamics of sulfamethoxypyridazine in ophthalmological practice
• Specific and nonspecific immunotherapy of allergic eye diseases
• Differential diagnosis of drug-induced and infectious conjunctivitis

Other topics in the "Additional Topics" section

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.