Ocular diseases, treatment

Many other ocular diseases have similar symptoms. Patients with suggestive symptoms without signs should be placed on a treatment trial. Repeated observations over time may be required for a clinical diagnosis. 

In as much as products for the diagnosis and treatment of ocular disease cover the spectrum of practically all dosage forms and, thus, require the same pharmaceutical sciences for their development, in this chapter we discuss the entire scope of considerations involved in the development of ophthalmic products, ranging from regulatory and compendial requirements, through physicochemical, safety, and efficacy considerations, to a discussion of types of dosage forms currently used by the medical practitioner. 

Clinical use of reversible inhibitors is directed to eye, skeletal muscle, neuromuscular junctions, gastrointestinal tract, urinary tract, respiratory tract, and heart and used in treatment of glaucoma (an ocular disease caused by increased intraocular pressure due to inadequate drainage of aqueous humor at filtration angle), myasthenia gravis (an autoimmune disease... 

Antimuscarinic drugs are widely used in ophthalmology to produce mydriasis and cycloplegia. These actions permit an accurate determination of the refractive state of the eye, and the antimuscarinics are also useful in treating specific ocular diseases and for the treatment of patients following iridectomy. 

When a patient with an ocular disease foils to respond to anti-infective therapy even though an appropriate treatment plan was developed and followed, a variety of explanations are possible. Box 11-2 outlines these explanations. 

Figure 24-5 Dynamics of tear flow. (From Kanski JJ. Clinical ophthalmology. Reprinted in Melroe. Evaluation of the lacrimal system. In Roberts and Terry eds. Ocular disease diagnosis and treatment, ed 2. Edinburgh Butterworth-Heinemann, 1996.)...

Underlying ocular disease, such as allergic conjunctivitis, chronic infectious or inflammatory disease, or contact lens-related disorders, should be properly managed either before or as an adjimct to treatment of lacrimal... 

With any of the connective tissue diseases the potential for recurrence is relatively high, and in most instances the disease becomes chronic. Therefore the practitioner must educate the patient to the potential for long-term involvement with the disease. Also, treatment of the ocular disease should not be undertaken in isolationiThe ophthalmic practitioner should consult with the patient s primary physician to optimize therapeutic management. 

The treatment of neurological and ocular diseases is particularly attractive for ECT. The CSF, brain parenchyma, and vitreous gel of the eye are all potential sites for implantation of encapsulated cells releasing therapeutic factors. Transplantation of encapsulated cells releasing therapeutic factors can bypass either the BBB or the BRB. However, long-term survival of encapsulated cells in these environments is challenged by the potential of cell overgrowth and the stressful environmental factors such as low 02 and poor nutrient flux. 

Any significant ocular disease (other than CNV) that has compromised or could compromise vision in the study eye and confound analysis of the primary outcome Inability to obtain photographs to document CNV, including difficulty with venous access History of treatment for CNV in study eye other than nonfoveal confluent laser photocoagulation... 

Pilocarpine is used principally as a diaphoretic, that is, to induce sweating, especially in nephritis, to relieve the kidneys and to remove toxic metabolites. The secretion of 3 liters of sweat can easily be achieved, and as much as 8 g. of nitrogen can be eliminated. The alkaloid is also employed as a milder substitute for physostigmine in the treatment of ocular diseases. Pilocarpine is reputed to stimulate the growth of hair, and jaborandi extracts are therefore employed to some extent as constituents of hair lotions. 

For instance, using this device, remotely operated dmg transport to ex vivo human eye tissue was reported for treatment of ocular diseases such as proliferative diabetic retinopathy... 

Lo R, Li P-Y, Saati S, Agrawal RN, Humayun MS, Meng E (2007) A passive MEMS dmg delivery pump for treatment of ocular diseases. Biomed Microdevices ll(5) 959-970... 

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