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Ocular irritationBronchospasmBradycardiaNightmaresExacerbation of hear failureMuscarinic (parasympathetic) simulates .Pilocarpine (also a differential for bilateral constricted pupils!)GlaucomaIncrease aqueous outflow viatrabecular meshwork by ciliary muscle contractionOcular: Misosis (reduced vision in the presence of a cataract) spasm of accommodation, brow acheSystemic: Swaeting,bradycardia, GI disturbanceAlpha2-stimulantsTopicalBrimonidine, ApraclonidineGlaucomaReduces aqueos secretion byselective stimulation of alpha2 and adrenocrecptors in the ciliary body increase outflow by the uveoscleral routeOcular: Iris darkening, conjunctival hyperaemia, eyelash growth.Systemic: bitter taste, asthma.Carbonic Anhydrase Acetazolamide (systemic)GlaucomaReduce aqueous secretion bythe cilliary bodyOcular route:
InhibitorsDorzolamide,Brinzolamideirritation and allergySystemic route: Malaise, paraesthesia, urea and electrolye disturbance, aplastic anaemiaMydriatics and cycloplegics – ( Used for retinal examination and objective refraction (retinoscopy)AntimuscarinicsTropicanamide, cyclopentolate, atropine.Eye dilation for examInhibit muscarinic receptors of parasympathetic nervous system to paralyse papillary sphincter and ciliary muscle.Ocular: Blurred vision, glare, angle closure glaucoma.Systemic: Tachycardia, dry mouth, confusion, tremor.Alpha-stimulantPhenylephrineEye dilation for examStimulates dilator muscle of the pupil no cycloplegic effect.Ocular: Blurred vision, glare, angle closure, glaucoma, conjunctival blanching.Systemic hypertensionLubricants – There are a wide rangeCarbomers, hyrpmellose, polyvinyl alcohol, liquid paraffinDry eyeExact mechanism depends on the agentOcular: Allergy, blurred visionAnt-Inflammatory Agents.Most important drugs are corticosteroids, a Variety of other drugs are available including systemic immnosuppressantsCorticosteroidsPrednisolone, betamethasone, dexamethasoneSuppress InflammationSuppresion of broad spectrum of inflammatory processes (see corticosteroids)Ocular: Glaucoma (especially with local administration), cataract (especially prolonged systemic use) exacerbation of some infections !!! e.g. herpes simplex. Systemic: Negligiblewith topical use, common and variedwith systemic administration.Mast cell stabilisersCromoglicate, nedocromil, lodoxamide.AllergyStabilise mast cellsOccular: IrritationAnti-Topical: AllergyBlock histamine receptorOccular route: