EENT- Glaucoma

Question 1

Which type of glaucoma?

• 95% of cases
• Insidious, peripheral vision loss
• Excavation (“cupping”) and pallor of the optic disk
• Intraoccular pressure is elevated due to reduced drainage of aqueous fluid through the trabecular meshwork
• Flow of aqueous fluid into the anterior chamber angle is obstructed

Answer 1

Primary open-angle

Question 2

Which type of glaucoma?

• 5%
• Acute, eye pain/blurriness
• Closure of a preexisting narrow anterior chamber angle
• Immediate treatment-refer to ophthalmologist

Answer 2

Primary angle-closure glaucoma

Question 3

What is the goal in treating primary open-angle glaucoma?

Answer 3

To decrease IOP

Question 4

How do we decrease IOP, the goal in treating primary open-angle glaucoma?

Answer 4

1. Increase aqueous drainage
2. Decrease aqueous production
3. Surgery if unresponsive to medications

Question 5

Which of the following is the first line treatment used to increase aqueous drainage in a pt with primary open-angle glaucoma?

–Prostaglandin analogues (lantanoprost, bimatoprost)

–Topical α adrenergics (alphagan)

–Topical cholinergics (pilocarpine)

Answer 5

1st line: Prostaglandin analogues (lantanoprost, bimatoprost)

2nd: Topical α adrenergics (alphagan)
3rd: Topical cholinergics (pilocarpine)

Question 6

Which of the following is the first line treatment used to decrease aqueous production in a pt with primary open-angle glaucoma?

–Topical and oral carbonic anhydrase inhibitor (cosopt, diamox)

–Topical β blockers (timolol)

Answer 6

1st line: Topical β blockers (timolol)

(the other medication is 2nd/3rd line)

Question 7

Which med?

•Mechanism:

• prostaglandin F2-alpha analog believed to reduce intraocular pressure by increasing the outflow of the aqueous humor

Answer 7

Prostaglandin analogues used to tx open angle glaucoma

Question 8

Which med?

•ADEs

–Blurred vision, burning and stinging, conjunctival hyperemia, foreign body sensation, itching, increased pigmentation of the iris

–abnormal hair growth

Answer 8

Prostaglandin analogues (used to tx open angle glaucoma)

Question 9

•Mechanism:

–Selective agonist for alpha2-receptors; causes reduction of aqueous humor formation and increased uveoscleral outflow

Answer 9

Topical α adrenergics (Brimonidine)- used to tx open angle glaucoma

Question 10

Which med?

•ADEs

–Allergic conjunctivitis, conjunctival hyperemia, eye pruritus

–Somnolence

–Hypertension, hypotension

–Hypercholesterolemia

Answer 10

–Topical α adrenergics (Brimonidine): tx for open angle glaucoma

Question 11

•Mechanism:

• Directly stimulates cholinergic receptors in the eye causing miosis (by contraction of the iris sphincter), loss of accommodation (by constriction of ciliary muscle), and lowering of intraocular pressure (with decreased resistance to aqueous humor outflow)

Answer 11

Topical cholinergics (pilocarpine)–> used to tx open angle glaucoma by increasing the aqueous drainage

Question 12

•ADEs

–Hypertension, tachycardia

–Diarrhea, nausea, salivation, vomiting

–Ocular: Burning, ciliary spasm, conjunctival vascular congestion, corneal granularity, lacrimation, lens opacity, myopia, retinal detachment, supraorbital or temporal headache, visual acuity decreased

– Bronchial spasm, pulmonary edema

–Diaphoresis

–May cause decreased visual acuity, especially at night or with reduced lighting

Answer 12

Topical cholinergics (pilocarpine)- used to tx open angle glaucoma by increasing the aqueous drainage

Question 13

•Mechanism:

–Blocks both beta1- and beta2-adrenergic receptors, reduces intraocular pressure by reducing aqueous humor production or possibly outflow

Answer 13

Topical β blockers (timolol)- used to tx open angle glaucoma by decreasing aqueous production

Question 14

•ADEs of_______?

• Angina pectoris, arrhythmia, bradycardia, cardiac arrest, cardiac failure, cerebral ischemia, cerebral vascular accident, edema, heart block, hypertension, hypotension, palpitation, Raynaud’s phenomenon
• Anxiety, confusion, depression, disorientation, dizziness, hallucinations, headache, insomnia, memory loss, nervousness, nightmares, somnolence
• Hypoglycemia masked, libido decreased
• Anorexia, diarrhea, dyspepsia, nausea, xerostomia
• Tinnitus
• Bronchospasm, cough, dyspnea, nasal congestion, pulmonary edema, respiratory failure

Answer 14

β blockers

Question 15

•Mechanism

–Dorzolamide: Inhibits carbonic anhydrase in the ciliary processes of the eye resulting decreased bicarbonate ion formation which decreases sodium and fluid transport, thus decreasing aqueous humor secretion and reduces intraocular pressure

Answer 15

Topical and oral carbonic anhydrase inhibitors (cosoft-dorzolamide (with timolol), diamox–> used to tx open angle glaucoma by decreasing aqueous production

Question 16

•ADEs for _____?

• Taste perversion
• Abdominal pain, dyspepsia, nausea
• And all of timolol’s

Answer 16

Dorzolamide