What are the ocular side effects of miotic drugs?
Miotic drugs commonly produce ocular side effects, including conjunctival injection, ocular and periocular pain (headache), twitching of the eyelids, fluctuating myopic shift in refraction, and decreased vision in dim illumination. Almost all of the ocular side effects are more common and more severe with the anticholinesterase agents ( Box 27-1 ).
What is a miotic agent in glaucoma?
Miotic Agent. Miotic agents help prepare an eye for iridotomy and are not a substitute for it in pupillary block angle-closure glaucoma. From: Becker-Shaffer's Diagnosis and Therapy of the Glaucomas (Eighth Edition), 2009. Download as PDF.
Do miotics have a cataractogenic effect?
The studies of Levene 99 suggest that standard miotics do have a mild cataractogenic effect. Cholinergic agents alter lens permeability in animal eyes, leading to a shift in lens cations and an accumulation of water. 96,97,100
What is the role of miotic therapy in the pathophysiology of cirrhosis?
Miotic therapy is associated with ciliary body congestion and breakdown of the blood–aqueous barrier, increasing the permeability to plasma proteins.
What is the effect of Miotic drug on eye?
Ocular side effects include miosis, accommodative spasm, frontal headaches, twitching lids, conjunctival injection, cataractous changes, allergic reactions, iris cysts, retinal detachment, increased permeability of the blood-aqueous barrier, anterior chamber narrowing, and the potential for inducing an acute angle- ...
Do miotic drugs dilate pupils?
Miosis caused by opioids and other medications Some drugs will cause your pupils to become very small. Pinpoint pupils are a known result of taking opioids and barbiturates. Other drugs, such as myotic drugs like pilocarpine, make pupils small.
How do miotics cause retinal detachment?
Miotics (applies to pilocarpine ophthalmic) retinal detachment. The use of miotic agents may occasionally cause retinal detachment due to drug-induced ciliary or accommodative spasm, which causes the lens and vitreous to move forward and create a retinal tear.
How do miotics cause cataracts?
Both miotics alter cation and water balance in the lens, causing an increased sodium, decreased potassium, and gain in lens water. The rapidity of onset and the severity of these lesions exhibit a dose dependency.
What is the action of Miotic drug?
Miotics (drugs that cause the pupil to contract) improve the outflow of aqueous as part of the treatment of glaucoma and reduce the risk of a posteriorly luxated lens entering the anterior chamber.
How do Miotics work to constrict the pupils?
Miotics work in two ways: Mimic a chemical known as acetylcholine (neurotransmitter) that nerve endings in muscles secrete and stimulate proteins (cholinergic receptors) on eye muscles which respond to acetylcholine and activate muscle contraction. Enhance acetylcholine activity by preventing its degradation.
How do miotics increase inflammation?
Miotics are avoided in uveitic glaucoma because of the risk of formation of posterior synechiae or a pupillary membrane. They also may increase inflammation by enhancing breakdown of the blood-aqueous barrier.
How pilocarpine can increase the risk of retinal detachment?
Topical pilocarpine ophthalmic drops may be associated with a risk of retinal detachment. We describe 3 cases of retinal detachment in 2 patients using pilocarpine drops for presbyopia. Pilocarpine causes anterior lens migration, which may induce tractional forces on the retina.
How many retinal detachments have been caused by pilocarpine?
Three cases of retinal detachment associated with use of pilocarpine eye drops were identified in this study.
Does miosis reduce intraocular pressure?
As an initial option for primary ACG treatment, miotics could induce the contraction of the sphincter pupillae, which could then pull the peripheral iris away from the trabecular meshwork and therefore reopen the angle, and finally decrease intraocular pressure (IOP) and control the progression of glaucoma.
Why are miotics used in glaucoma?
Miotics (drugs that cause the pupil to contract) improve the outflow of aqueous as part of the treatment of glaucoma and reduce the risk of a posteriorly luxated lens entering the anterior chamber.
What is the meaning of miotic?
adjective. of or relating to or causing constriction of the pupil of the eye. “a miotic drug” synonyms: myotic. a drug that causes miosis (constriction of the pupil of the eye)
What medication causes dilated pupils?
What medications cause my pupils to dilate?Antidepressants.Antihistamines.Anti-nausea medications.Anti-seizure medications.Atropine.Botulinum toxin.Medications for Parkinson's disease.
What drug makes pupils constrict?
Narcotic drugs, either legal or illicit, can constrict pupils. These include heroin, morphine, hydrocodone, and fentanyl. Overdose on these drugs can also lead to pinpoint pupils (when eyes don't respond to changes in light).
What causes dilated pupils?
Your pupils get bigger or smaller, depending on the amount of light around you. In low light, your pupils open up, or dilate, to let in more light. When it's bright, they get smaller, or constrict, to let in less light. Sometimes your pupils can dilate without any change in the light.
Why do antidepressants dilate pupils?
Because they affect involuntary muscles, they may influence the small muscles in your iris, causing them to pull your iris open wider. Antidepressants: These can affect both serotonin and norepinephrine, which also affect muscles, including in your eyes.
What is the purpose of miotics?
Miotics (drugs that cause the pupil to contract) improve the outflow of aqueous as part of the treatment of glaucoma and reduce the risk of a posteriorly luxated lens entering the anterior chamber.
What are the side effects of miotics?
Miotic drugs commonly produce ocular side effects, including conjunctival injection, ocular and periocular pain (headache), twitching of the eyelids, fluctuating myopic shift in refraction, and decreased vision in dim illumination. Almost all of the ocular side effects are more common and more severe with the anticholinesterase agents ( Box 27-1 ). Patients are more likely to accept the side effects if the physician provides encouragement, explains that the symptoms improve spontaneously over the first several days, and initiates treatment with a low concentration of the cholinergic drug. Pain and headache can be relieved by salicylates. Older patients, particularly those with lens opacities, often complain of decreased vision in dim illumination. They should be warned about the dangers of driving at night. Some of these patients may be helped by concomitant treatment with phenylephrine. Other alternatives include a prostaglandin-like agent, β-adrenergic antagonists, an α-adrenergic agonist, a topical carbonic anhydrase inhibitor, the Ocusert delivery system, and pilocarpine gel.
What is isoflurophate used for?
Isoflurophate is a long acting cholinesterase inhibitor and potent miotic. It works as an indirect acting parasympathomimetic agent to reduce intraocular pressure. Also known as diisopropyl phosphofluoridate (Dyflos), it is an irreversible organophosphate cholinesterase inhibitor. It and its analogues were studied extensively during the Second World War as substances that could be employed as war gases because of their volatility and rapid absorption from the lungs. Due to its toxicity it is only used in the treatment of patients with open angle glaucoma or other chronic glaucomas which are not controlled with other less toxic short acting agents.
How to treat opiate overdose?
Treatment of opiate overdose involves providing respiratory support and administering naloxone, a pure opiate antagonist. Naloxone is typically administered IV but may also be administered SC, intramuscularly (IM), via endotracheal tube, or intranasally until IV access is established (Barton et al., 2005). The initial dose is typically 0.4 to 0.8 mg, with a 2-minute onset of action when given IV. Doses are repeated and escalated as needed to reverse the overdose. After reversal, patients need to be monitored for 1 to 3 hours for repeated dosing, and sometimes longer if longer-acting opiates such as methadone have been used in the overdose. Naloxone treatment can initiate a rapid and intense withdrawal syndrome (Ries et al., 2009).
Does anticholinesterase cause cysts?
Anticholinesterase therapy leads to proliferation of the pigment epithelium of the iris, forming cysts near the pupillary margin ( Fig. 27-5 ). 103 The cysts may narrow the anterior chamber angle, increasing the risk of angle closure. Furthermore, the combination of a tiny pupil and a peripupillary epithelial cyst may significantly interfere with vision. Concomitant administration of topical phenylephrine may inhibit the proliferation or make it less apparent. The cysts decrease in size after the anticholinesterase drug is discontinued.
Does miotics help with glaucoma?
For this reason, miotics are formally contraindicated in eyes with aqueous misdirection.
Is pilocarpine contraindicated for phacomorphic glaucoma?
Hence, pilocarpine is formally contraindicated in eyes with phacomorphic glaucoma or other conditions where the glaucoma is caused by anterior displacement of the iris/lens diaphragm.
What drugs cause miosis?
methadone. Other drugs and chemicals that can cause miosis include: PCP (angel dust or phencyclidine) tobacco products and other nicotine-containing substances. pilocarpine eye drops used to treat glaucoma. clonidine, which is used to treat high blood pressure, ADHD, drug withdrawal, and menopausal hot flashes.
What causes miosis in the brain?
It can be a symptom of certain brain and nervous system conditions. It can also be induced by many types of drugs and chemical agents. Opioids (including fentanyl, morphine, heroin, and methadone) can produce miosis.
What causes pupil contraction?
Usually miosis or pupil contraction is caused by a problem with your iris sphincter muscles or the nerves that control them. The iris sphincter muscles are controlled by nerves that originate near the center of your brain.
What causes a decrease in pupil size?
Iris inflammation (iridocyclitis). Decreased pupil size (miosis) can be a symptom of inflammation of your iris, the colored portion of your eye. Iris inflammation can have many causes. These include:
Is miosis a disease?
Miosis is a symptom of something else and not a disease in itself. It can provide an important clue to your doctor in finding the underlying cause.
Is miosis a sign of drug overdose?
The condition isn’t normally painful or dangerous in itself. But it can be a marker for some serious conditions including stroke, drug overdose, or organophosphate poisoning.
Can miosis occur in both eyes?
Miosis can occur in one or both eyes. When it affects only one eye, it’s also called anisocoria. Another name for miosis is pinpoint pupil. When your pupils are excessively dilated, it’s called mydriasis. There are many causes of miosis. It can be a symptom of certain brain and nervous system conditions.