GLAUCOMA

Question 1

What is Glaucoma?

Answer 1

• Raised IOP = damage of optic nerve
• Damage can also occur at normal pressure
• Open-angle = most common
• Primary angle closure = medical emergency

Question 2

OAG

Answer 2

• blockage in the trabecular meshwork
• drains the anterior chamber of the eye to the episcleral veins through the Schlemm’s canal

Question 3

OAG - symptoms

Answer 3

• Usually asymptomatic (unless in advancing stage)
• worsening vision
• Raised intraocular pressure

Question 4

OAG - management

Answer 4

1. Beta-blockers (Local)
2. Prostaglandin analogues
3. Sympathomimetics
4. Carbonic anhydrase
   inhibitors
5. Miotics

Question 5

List the beta-blockers used in OAG

Answer 5

1. Betaxolol
2. Levobunolol
3. Timolol

Question 6

How do beta-blockers work in OAG?

Answer 6

• By reducing the rate of production of aqueous humour

Question 7

What are the
contraindications and side effects of beta-blockers for OAG?

Answer 7

• SAME AS SYSTEMIC
• Therefore cautioned (if applied locally) in asthma and
  COPD
• Other side effects are local e.g. discomfort, eye inflammation

Question 8

List the prostaglandin analogues

Answer 8

1. Latanoprost
2. Tafluprost
3. Travoprost
4. Bimatoprost

Question 9

How do prostaglandin analogues work?

Answer 9

• They increase uveoscleral outflow and subsequently reduce intra-ocular pressure

Question 10

What are the main side-effects of prostaglandin
analogues you should be aware of?

Answer 10

1. Changes to eye colour
   - An increase in brown pigments to the iris can occur
2. Changes to eyelashes (increase length)
   - Warn patients that if they apply the medication to the surrounding skin, it can increase hair growth

Question 11

List the
sympathomimetics used in OAG.

Answer 11

1. Brimonidine
2. Apraclonidine

Question 12

How do
sympathomimetics work in OAG?

Answer 12

• They are alpha2-adrenoreceptor agonists
• They lower intra-ocular pressure by reducing aqueous humour formation and increasing uveoscleral outflow

Question 13

When are
sympathomimetics used in OAG?

Answer 13

• When intra-ocular pressure is not controlled with beta-blockers
• Or in addition to other treatments

Question 14

List the carbonic anhydrase inhibitors used in OAG

Answer 14

1. Acetazolamide
2. Brinzolamide
3. Dorzolamide

Question 15

How do carbonic anhydrases work?

Answer 15

• They reduce intra-ocular pressure by reducing aqueous humour production
• Usually used when resistant to beta-blockers or in addition to other drugs

Question 16

Which Miotic is used in glaucoma?

Answer 16

Pilocarpine

Question 17

Is Pilocarpine normally used in open-angle glaucoma?

Answer 17

• No, poorly tolerated due to side-effects
• Normally used in close-angle glaucoma