Glaucoma

Question 1

Background of Glaucoma

Answer 1

Group of progressive optic neuropathies with characteristic visual field defects and structural change in the optic nerve head.
- 3% prevalence in Australia.

Risk factors
- Age > 65yo
- First Degree Family history
- Race (African > White > Asian)
- Myopia
- Vasospastic Conditions (migrains or Raynaud phenomenon)
- OSA
- Diabetes
- Hypertension
- Cardiovascular disease

Symptoms
- Visual symptoms often late feature of glaucoma.

Question 2

Pharmacological Management of open-angle Glaucoma

Answer 2

• Prostaglandin Analogue eye drops
  
  • Latanoprost (Xalatan)
  • 1st line. OD dosing.
  • Reduces IOP
  • SE: Hypertrichosis of eyelashes. Periocular skin pigmentation. Increase in iris pigmentation in lighter coloured eyes.
• Beta blocker eye drops
  
  • Reduces IOP. Bind to ciliary body to reduce aqueous humour production.
  • Timolol
  • SE: Bronchoconstriction, Ocular irritation, bradyarrhythmias, hypotension.
• Alpha-2-agonist eye drops
  
  • Brimonidine
  • SE: Conjunctival hyperaemia. Dry mouth, drowsiness.
• Carbonic Anhydrase inhibitors
  
  • Least effective. Used as 3rd or 4th line agent. Generally well tolerated.
  • Dorzolamide