BNF for Children 2011-2012

528 11.6 Treatment of glaucoma BNFC 2011–201211 EyeDORZOLAMIDECautions systemic absorption follows topical application;history of renal calculi; neonates and infants withimmature renal tubules—risk of metabolic acidosis;chronic corneal defects, history of intra-ocular surgery;interactions: Appendix 1 (dorzolamide)Contra-indications hyperchloraemic acidosisHepatic impairment manufacturer advises caution—no information availableRenal impairment see Cautions above; also avoid ifestimated glomerular filtration rate less than 30 mL/minute/1.73 m 2Pregnancy manufacturer advises avoid—toxicity inanimal studiesBreast-feeding manufacturer advises avoid—noinformation availableSide-effects nausea, bitter taste; headache, asthenia;ocular irritation, blurred vision, lacrimation, conjunctivitis,superficial punctuate keratitis, eyelidinflammation; less commonly iridocyclitis; rarelyhypersensitivity reactions (including urticaria, angioedema,bronchospasm), dizziness, paraesthesia, urolithiasis,eyelid crusting, transient myopia, cornealoedema, epistaxis, dry mouth, throat irritation; alsoreported metabolic acidosisLicensed use not licensed for use in childrenIndication and doseRaised intra-ocular pressure in ocular hypertension,open-angle glaucoma, pseudo-exfoliativeglaucoma either as adjunct to betablockeror used alone in patients unresponsiveto beta-blockers or if beta-blockers contraindicatedUsed alone, apply 3 times daily; with topical betablocker,apply twice dailyDorzolamide (Non-proprietary) AEye drops, dorzolamide (as hydrochloride) 2%, netprice 5 mL = £5.61Excipients may include benzalkonium chlorideBrands include Dorzant cTrusopt c (MSD) AOphthalmic solution (= eye drops), in Ocumeter cPlus metered-dose unit, dorzolamide (as hydrochloride)2%, net price 5 mL = £6.33Excipients include benzalkonium chlorideUnit dose eye drops, dorzolamide (as hydrochloride)2%, net price 60 0.2 mL = £24.18With timololFor prescribing information on timolol, see section11.6, Beta-blockersDorzolamide with Timolol (Non-proprietary) AEye drops, dorzolamide (as hydrochloride) 2%,timolol (as maleate) 0.5%, net price 5 mL = £10.05Excipients may include benzalkonium chlorideCosopt c (MSD) AOphthalmic solution (= eye drops), in Ocumeter cPlus metered-dose unit, dorzolamide (as hydrochloride)2%, timolol (as maleate) 0.5%, net price5 mL = £10.05Excipients include benzalkonium chlorideUnit dose eye drops, dorzolamide (as hydrochloride)2%, timolol (as maleate) 0.5%, net price 60 0.2 mL =£28.59DoseRaised intra-ocular pressure in open-angle glaucoma,or pseudoexfoliative glaucoma when beta-blockersalone not adequateApply twice dailyMioticsPilocarpine is a miotic used in the management ofraised intra-ocular pressure. The small pupil is anunwanted effect of these drugs (except when pilocarpineis used temporarily before an operation forangle-closure glaucoma). Miotics act by opening upthe inefficient drainage channels in the trabecular meshwork.Cautions A darkly pigmented iris may require a higherconcentration of the miotic or more frequent administrationand care should be taken to avoid overdosage.Retinal detachment has occurred in susceptible individualsand those with retinal disease; therefore fundusexamination is advised before starting treatment with amiotic. Care is also required in conjunctival or cornealdamage. Intra-ocular pressure and visual fields shouldbe monitored in those with chronic simple glaucomaand those receiving long-term treatment with a miotic.Miotics should be used with caution in patients withpeptic ulceration, gastro-intestinal spasm, cardiac disease,hypertension, hypotension, asthma, epilepsy,hyperthyroidism, and urinary-tract obstruction.Counselling Blurred vision may affect performance of skilledtasks (e.g. driving) particularly at night or in reduced lightingContra-indications Miotics are contra-indicated inconditions where pupillary constriction is undesirablesuch as acute iritis, anterior uveitis and some forms ofsecondary glaucoma. They should be avoided in acuteinflammatory disease of the anterior segment.Pregnancy Miotics should be avoided unless thepotential benefit outweighs the risk—limited informationavailable.Breast-feeding Miotics should be avoided unless thepotential benefit outweighs the risk—no informationavailable.Side-effects Ciliary spasm leads to headache andbrowache which may be more severe in the initial 2–4weeks of treatment. Ocular side-effects include burning,itching, smarting, blurred vision, conjunctival vascularcongestion, myopia, lens changes with chronic use,vitreous haemorrhage, and pupillary block. Systemicside-effects are rare following application to the eye.PILOCARPINECautions see notes aboveContra-indications see notes aboveSide-effects see notes aboveLicensed use not licensed for use in children