Glaucoma and ocular hypertension

Question 1

What are the characteristics of glaucoma?

Answer 1

At first, there are minor vision field defects. Later, peripheral vision is impaired.

Sudden eye pain, loss of vision, nausea and vomiting - acute angle closure = emergency

Question 2

What are the risk factors for glaucoma?

Answer 2

Intra-ocular pressure
Family history
Age
Diabetes type 2
Cardiovascular disease
Hypertension
Corticosteroid use 
Ethnicity

Question 3

What is the difference between open-angle glaucoma and acute-angle closure glaucoma?

Answer 3

open angle glaucoma (most common) is when drainage of aqueous humour through the trabecular meshwork is redistricted and angle between the iris and cornea is normal. Starts off asymptomatic but can lead to irreversible sight loss or visual field defects.

Acute angle closure glaucoma (less common) when drainage is completely blocked and so symptoms are sudden and abrupt. Medical emergency that requires urgent reduction of intra ocular pressure to prevent loss of vision

Question 4

What is first line eye drops for someone with intra-occular pressure of more than 24mmHG?

What if pressure less than this?

Answer 4

Topical prostaglandin analogue

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

No treatment should be monitored for changes in intra-ocular pressure and visual impairment

Question 5

What is 2nd line eye drops for someone with intra-ocular pressure of more than 24mmHG?

Answer 5

Try alternative prostaglandin analogue

then topical beta-blocker e.g. betaxolol or timolol