POAG

Question 1

Features

Answer 1

peripheral visual field loss - nasal scotomas progressing to ‘tunnel vision’
decreased visual acuity
optic disc cupping

Question 2

Cup disc ratio

Answer 2

> 0.7

Question 3

Mx of pOAG

Answer 3

first line: prostaglandin analogue (PGA) eyedrop
second line: beta-blocker (timolol), carbonic anhydrase inhibitor (dorzolamide), or sympathomimetic eyedrop (pilocarpine)

Question 4

Increases uveoscleral outflow

Once daily administration

Adverse effects include brown pigmentation of the iris, increased eyelash length

Answer 4

Prostaglandin analogues (e.g. latanoprost)

Question 5

Reduces aqueous production
Should be avoided in asthmatics and patients with heart block

Answer 5

Beta-blockers (e.g. timolol, betaxolol)

Question 6

Reduces aqueous production and increases outflow

Avoid if taking MAOI or tricyclic antidepressants

Adverse effects include hyperaemia

Answer 6

Sympathomimetics (e.g. brimonidine, an alpha2-adrenoceptor agonist)

Question 7

Reduces aqueous production Systemic absorption may cause sulphonamide-like reactions

Answer 7

Carbonic anhydrase inhibitors (e.g. Dorzolamide)

Question 8

Increases uveoscleral outflow Adverse effects included a constricted pupil, headache and blurred vision

Answer 8

Miotics (e.g. pilocarpine, a muscarinic receptor agonist)

Question 9

Surgical management

Answer 9

trabeculectomy