glaucoma

Question 1

pathophysiology of glaucoma

Answer 1

Group of disorders
◼ Raised intra ocular pressure (IOP)…how much? ◼ Optic nerve head damage, cupping of optic disc ◼ Loss visual field
◼ 73 million suffers worldwide
◼ Second principal cause of blindness (after?????)
◼ IOP dependent on aqueous humour production and outflow

Question 2

clinical manifestations of glaucoma? which one is worse?

Answer 2

PACG is more serious that POAG.

• PACG needs emergency treatment to reduce IOC
• PACG more likely to cause blindness

Question 3

POAG Risk factors?

Answer 3

• over 40
• diabetic
• family history
• mypoia: short sighted people

Question 4

POAG symptoms ?

Answer 4

pts are usually asymptomatic until its too late and there vision is gone
-no pain or discomfort

glaucoma is usually identifies in screening

symptoms of acute POAG are:

• halo in the eye
• cloudiness
• blurred vision
• redness
• n&v

Question 5

POAG signs?

Answer 5

• impaired vision

- raised IOP, up to 50% axons lost

Question 6

how are eyedrops administered?

Answer 6

lower eyelid is pulled back and drop is placed in pocket

close eyes for as long as you can

wait 1-2 mins

Question 7

eye ointment administration ?

Answer 7

1cm amount
same as eye drops

blinking helps spread

Question 8

systemic effects of applying drugs to the eyes? and how can this be minimised

Answer 8

there are blood vessels in the eye as well as the nasal mucosal route and this can cause systemic symptoms

to reduce increase pressure on lacrimal punctum

Question 9

preservatives in eye treatments

Answer 9

preservatives help last longer to reduce microbial activity

most common preservative used is benzakonium chloride

there is a preservative free option in the UK

Question 10

Beta blockers for glaucoma?

Answer 10

Beta blocks reduce IOP by reducing rate of production of aqueous humour

examples are timolol, carvedolol, , bexatolol

Question 11

beta blockers for glaucoma contraindications and side effects?

Answer 11

contraindicated in COPD, HF, Bradycardia and asthma as there is a risk of bronchospasm , therefore you need to use the first line treatment of prostaglandin analogues

Beta blockers local side effects:

• stinging
• erythema
• itching

Question 12

prostaglandin analogues for glaucoma how do they work?

examples? what else is it used for?

Answer 12

Prosaglandin analogues increase uveoscleral outflow and reduce IOP

examples include:

• Latanoprost
• Bimatoprost
• Travoprost

prostaglandin analogues are also used for ocular hypertension

and they’re licensed to use with beta blockers in combination

Question 13

prostaglandin side effects

Answer 13

change in eye colour to a more brown shade

thicker and darker eyelashes

photophobia

headaches

Question 14

carbonic anhydrase inhibitors how do they work and examples of how they’re used

Answer 14

• brinzolomide
• dorzolamide

carbonic anhydrase inhibitors work by reducing aqueous humour production

used when b blockers are contraindicated

Question 15

ho do sympathomimetics work and give examples

Answer 15

sympathomimetics work in two ways:

• decrease aqueous humour production
• increase uveosteal outflow

examples are:

-briminidine : selective alpha adrenoreceptor agonist

-apraclonidine
reduce aqueous humour production

Question 16

how are moitics used in glaucoma and examples

Answer 16

they work by opening inefficient drainage channels

example is pilocarpine ( qds)