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Extra info for Drugs and the Eye. Sponsored by the British Optical Association
The amide link Ο NH — C — CH 2 — as in lignocaine is much more resistant to hydrolysis and therefore local anaesthetics with this link are likely to be longer acting. Local anaesthetics are weak bases, relatively insoluble in water and rather unstable. They readily form water-soluble salts of strong acids which are stable in solution. Local anaesthetics are therefore generally supplied as the hydrochloride salt. The unionized form is important for absorption. However, it is the ionized form, the cation, which is responsible for the local anaesthetic effect.
PRACTICAL ASPECTS Homatropine is weaker than atropine and cannot produce a complete cycloplegia. It is therefore useful in young adults where complete cycloplegia is not necessary and a shorter recovery time is advantageous. The cases in which homatropine finds most use are those in which a quietening of accommodation allows the true refractive state to be determined, for example, in young people who have restless and spasmodic accommodation, in those patients where the optician suspects a latent error, and in pseudomyopia where it is necessary to break down the spasm to reveal the true error.
Lachesine After instillation of 2 drops of a 1 per cent solution the maximum mydriatic effect is reached in about 1 hour and lasts 5—6 hours. It is a less potent cycloplegic than atropine. 002 per cent Purified water to 100 per cent This drug may be used in patients with atropine allergy. Tropicamide This compound is of interest because its mydriatic action is reputed to be more marked than its cycloplegic action. 5 or 1 per cent solution mydriasis is rapid in onset, reaching maximum in 15—30 minutes.