Elle possède une action plus rapide et moins longue que l'atropine. Ces deux derniers principes actifs ne sont pas utilisables dans le traitement des uvéites du fait de leur brève durée d'action. Ils ont surtout un usage diagnostique. Les autres collyres sont fréquemment utilisés pour leur action vasoconstrictrice dans les irritations conjonctivales. Avec ces derniers collyres il n'y a jamais de mydriase ni de GFA et il ne devrait donc pas y avoir de contre-indications pour ce type de spécialités.
Après instillation dans l'oeil, l'apraclonidine entraîne une réduction de la pression intra-oculaire PIO grâce à une baisse de la formation de l'humeur aqueuse.
Elle est indiquée pour prévenir ou contrôler les élévations post-chirurgicales de la PIO chez les patients venant de subir une intervention au laser au niveau du segment antérieur. Cette mydriase est décrite en effet indésirable mais ne fait pas l'objet d'une contre-indication ni d'une précaution d'emploi.
Du fait de cette sélectivité, on n'observe aucune mydriase ni vasoconstriction des microvaisseaux, contrairement à l'apraclonidine. Ces substances ont une action indirecte de type parasympathomimétique par blocage de la cholinestérase et entraînent un effet myotique puissant et prolongé. Ses indications sont restreintes glaucome de l'aphaque ne présentant aucune prédisposition au décollement de la rétine….
Les solutions destinées aux administrations nasales, dangereuses en cas de GFA, sont représentées par les décongestionnants utilisés dans les rhinites aiguës de l'adulte. Cependant leur utilisation devrait être courte en raison du risque d'atrophie muqueuse irréversible dans les rhinites chroniques. L'inscription à la liste II des spécialités contenant des vasoconstricteurs a supprimé leur utilisation comme médicament conseil en officine, mais n'a pas éliminé complètement les risques d'automédication.
Toutefois, cette spécialité fait l'objet d'une précaution d'emploi en raison du risque de GFA lors d'une projection accidentelle oculaire en cas de mauvaise manipulation chez les sujets prédisposés. Les médicaments à usage général cure amaigrissement sud ouest emploi des classes pharmacologiques et cliniques très diverses.
Ils sont classés selon les disciplines anatomo-cliniques traditionnelles. Ces deux produits existent sous forme injectable la plus dangereuse mais aussi sous forme orale ou rectale. Atropine : formes injectables par voie intraveineuse utilisées notamment dans les bradycardies sinusales et les blocs auriculo-ventriculaires. Ce sont des produits conseils utilisés comme décongestionnants oculaires :. Il provoque la libération des catécholamines à partir des granules de stockage et inhibe leur recapture d'où une déplétion en catécholamine dans le neurone et une hypersensibilité à l'adrénaline.
Il est utilisé en association avec un collyre à l'adrénaline en vue de sa potentialisation et permet ainsi une réduction des doses de celle-ci. Décongestionnants utilisés dans les rhinites à base de :.
C'est ainsi que les préparations galéniques à base de solanacées ne sont plus admises dans les laxatifs et les antitussifs. De même est préconisé le retrait de l'éphédrine de certaines spécialités compte tenu de ses effets indésirables cardio-vasculaires et cérébraux.
Ceci a permis de traiter des glaucomateux à angle ouvert avec ces médicaments de manière plus aisée. En effet, les prescripteurs, auparavant, n'osaient pas utiliser ces médicaments du fait de l'ambiguïté du libellé au chapitre contre-indication glaucome sans précision supplémentaire. Notre travail fait le recensement des spécialités impliquées dans les risques de déclenchement de glaucome aigu par fermeture de l'angle. La difficulté principale dans l'interprétation des données est l'établissement d'une réelle échelle de risque.
Les collyres semblent être les plus dangereux du fait de leur utilisation sur le site même du déclenchement de la crise, ainsi que, dans une moindre mesure, les médicaments utilisés dans la région de l'oeil produits rhinologiques et aérosols dans le traitement des crises d'asthme. Toutefois, il est difficile d'établir une échelle de risque en fonction des collyres.
Ils ne sont pas dangereux en eux-mêmes, c'est seulement la mydriase engendrée qui peut l'être chez les sujets prédisposés. Chez de tels patients, toute mydriase est dangereuse, quel que soit le produit utilisé. Le risque majeur n'est pas tant la dilatation complète mais la semi-mydriase. C'est pourquoi la crise de GFA ne s'observe pas immédiatement après instillation des gouttes, mais quelques heures après, au moment de la décroissance de l'effet mydriatique en dehors du cabinet du médecin.
Chez les sujets à risque, patients anatomiquement prédisposés ou ayant eu des crises de GFA spontanément résolutives, des tests de provocation sous surveillance attentive peuvent être utilisés avec le tropicamide  ou l'association pilocarpine — néosynéphrine .
En outre, il existe une limite de l'information officielle : par exemple, pour une même molécule comme la pseudoéphédrine, les monographies des différentes spécialités existantes ne mettent pas le risque de GFA sur un même pied d'égalité certaines seront contre-indiquées, d'autres présenteront uniquement une précaution d'emploi, et d'autres ne feront l'objet d'aucune précaution.
Biométrie in : Le glaucome primitif à angle fermé. Simep, Villeurbanne, Narrow-angle glaucoma presenting as acute, painless visual impairment. Ann Emerg Med, ; Acute angle closure glaucoma presenting in a young patient after administration of paroxetine. Eye, ;14 Pt 3a Angle-closure glaucoma in a year-old-girl. Am J Ophthalmol, ; Contre-indications médicamenteuses dans le glaucome par fermeture de l'angle.
In : Le glaucome primitif à angle fermé. Symposium de Bordeaux. Villeurbane : Simep, Pharmacologie clinique : bases de la thérapeutique 2 e éditionExpansion Scientifique Française, Paris,Guide pratique des médicaments, 19 e éd. Paris : Éditions Maloine, Glaucome et médicaments, page X. Tables d'utilisation des médicaments 4 e éditionÉditions Frison-Roche, Paris, Médicaments à potentiel anticholinergique.
Thérapie, ; Angle-closure glaucoma precipitated by the use of phospholine iodide for esotropia in a child. Br J Ophthalmol, ; Glaucome à angle fermant provoqué par la phospholine iodide et l'épinéphrine dans un cas de glaucome à angle ouvert. Arch Ophthalmol, ; Nebulised ipratropium bromide and salbutamol causing closed-angled glaucoma. Lancet, ;2 Acute angle closure glaucoma associated with nebulised ipratropium bromide and salbutamol.
BMJ, ; Ipratropium bromide induced angle closure glaucoma. N Z Med J, ;95 Acute angle closure glaucoma occuring after nebulized bronchodilatator treatment with ipratropium bromide and salbutamol. J R Soc Med, ; Acute angle-closure glaucoma as a complication of combined beta-agonist and ipratropium bromide therapy in the emergency department.
The effect of nebulized bronchodilatator therapy on intraocular pressures in patients with glaucoma. Chest, ; Le glaucome aigu iatrogène. Enquête sur les facteurs déclenchants. Ouest Méd, ; Acute angle closure bio essence pigmentation cream following botulinum toxin.
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