Hyperosmotic agents

Glaucoma Management of open-angle (chronic simple) glaucoma may be used in combination with miotics, beta blockers, hyperosmotic agents, or carbonic anhydrase inhibitors. 

Concomitant therapy Cholinesterase inhibitors may be used in combination with adrenergic agents, -blockers, carbonic anhydrase inhibitors, or hyperosmotic agents. 

Osmotherapy was introduced to ocular therapeutics in 1904 with the use of oral hypertonic saline to reduce elevated intraocular pressure.Topical ocular use of hyperosmotic agents has been proven clinically useful in the treatment of corneal edema, particularly when the cause is endothelial dysfunction. 

The following discussion considers the pharmacologic properties of hyperosmotic agents available for topical use. Chapter 26 discusses the clinical uses of topical osmotherapy in the management of conditions characterized by corneal edema. 

Topical hyperosmotic agents can be useful in dehydrating edematous corneas. The clinical objective of topical... 

Sodium chloride is a component of all body fluids, including tears. A solution of 0.9% is approximately isotonic with tears. Of the various concentrations tested, 2% to 5% formulations have proven effective, with an irritation level acceptable to most patients. Studies comparing various hyperosmotic agents in human subjects have confirmed the usefulness of hypertonic sodium chloride in the treatment of corneal edema. Use of 5% sodium chloride in ointment form can be effective in reducing corneal thickness and in improving vision.The maximum reduction in corneal thickness occurs 3 to 4 hours after instillation of the ointment (Figure 15-1). 

Bartlett JD, FisceUa RG, Jaanus SD, et al. Hyperosmotic agents. Ophthalmic drug facts. St. Louis, MO J.B. Lippincott, 2006 249-258. 

Lamberts DW.Topical hyperosmotic agents and secretory stimulants. hit Ophthalmol Clin 1980 20 163-169. 

Ocular irrigating solutions and disinfectants 242 Viscoelastic materials 242 Intracameral fibrinolytic agents 242 Topical hyperosmotic agents 242 Ocular tissue adhesives 242... 

Lactulose is a hyperosmotic agent, which produces increased osmotic pressure within colon and acidifies its contents, resulting in increased stool water content and stool softening. It causes migration of ammonia from blood into colon, where it is converted to ammonium ion and expelled through laxative action. It is indicated in the treatment of constipation and prevention and treatment of portal-systemic encephalopathy, including stages of hepatic precoma and coma. 

Pickett PM, Izfar S, MacKanos MA, Virostko J, Jansen ED. Use of hyperosmotic agent to increase spatial resolution of optical imaging of photoactive reporter genes. Laser Slug Med Unpublished data. 

R.K. Wang, X. Xu, Y. He, and J.B. Elder, Investigation of Optical Clearing of Gastric Tissue Immered with Hyperosmotic Agents, IEEE J. Select. Tops. Quant. Electr., vol. 9,2003. 234-242. 

X. Xu and R.K. Wang, Synergetic Effect of Hyperosmotic Agents of Dimethyl Sulfoxide and Glycerol on Optical Clearing of Gastric Tissue Studied with Near Infrared Spectroscopy, Phys. Med. Biol, vol. 49,2004, pp. 457-468. 

Y. He and R.K. Wang, Dynamic Optical Clearing Effect of Tissue Impregnated with Hyperosmotic Agents and Studied with Optical Coherence Tomography, J. Biomed. Opt., vol. 9, 2004, pp.200-206. 

G. Vargas, A. Readinger, S. S. Dosier, and A.J. Welch, Morphological changes in blood vessels produced by hyperosmotic agents and measured by optical coherence tomography, Photochem. Photobiol, voL 77, no. 5, 2003, pp.541-549. 

Hirsh, A. J. (2002). "Altering airway surface liquid volume inhalation therapy with amiloride and hyperosmotic agents." Adv Drug DelivRev, 54(11), 1445-62. 

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