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CHAPTER 12
Ophthalmology
Prepared by
Ms. Gunjegaonkar Manjushree B.
SJVPM’S Rasiklal
LEARNING OBJECTIVES.
After studying the chapter, students will be able to:
 Understand the Etiopathogenesis of ophthalmic diseases
 Explain the subjective and objective features in ophthalmic diseases
 Understand rational use of medicine in ophthalmic diseases
 Provide well planned procedures of prevention of ophthalmic diseases.
Introduction
Ophthalmology is a branch of medicine that deals with the diagnosis and treatment of
eye disorders. Ophthalmology is the specialized field of medicine that focuses on the
health of the eye. It includes the anatomy, physiology and diseases that may affect the eye.
Historically, the science of ophthalmology encompassed all aspects of visual function,
both in health and in illness.
Most common ophthalmic diseases are;
• Conjunctivitis
• Proptosis (bulged eyes)
• Eye tumors
• Diabetic retinopathy
• Dry eye syndrome
• Glaucoma
Conjunctivitis
The conjunctiva is a thin membrane that covers the inner surface of the eyelid and the
white part of the eyeball (sclera).Conjunctivitis is the inflammation of conjunctiva, which
makes the white part of the eye appear red
Conjunctivitis is an inflammation or infection of the transparent membrane (conjunctiva)
that lines the eyelid and covers the white part of the eyeball. When small blood vessels in
the conjunctiva become inflamed, they're more visible. This is what causes the white part
of the eyes to appear reddish or pink, it is also known as “PINK EYE”
It can be caused by allergies or a bacterial or viral infection. Conjunctivitis can be
extremely contagious and is spread by contact with eye secretions from someone who is
infected.
Risk Factors
• Exposure to something for which the person have an allergy (allergic conjunctivitis)
• Exposure to someone infected with the viral or bacterial form of conjunctivitis
• Using contact lenses frequently
• Microbial infection (Chlamydia), fungus etc.
Clinical manifestation
The signs and symptoms and characteristic features of most cases of conjunctivitis are as
follows;
• Tenderness of the eye, or pain (which can be severe in the cases of irritant
conjunctivitis) & Swelling of conjunctiva (chemosis)
• Itchiness
• Body aches
• Photophobia
• Redness of the eye or inner eyelids (hyperemia)
• Discharge and tear (epiphora)
• Drooping of upper eye lid
• Periorbital cellulitis
• Fever ,Sore throat ,Runny nose
• Swelling of the eyelids
• Infection usually begins with one eye, but can quickly spread to other eye in cases of
viral or bacterial conjunctivitis
Etiopathogenesis:
1. Viral conjunctivitis – Adenovirus, HSV
2. Bacterial conjunctivitis – Staphylococcus aureus, Streptococcus pneumoniae,
Haemophilus influenza, Chlamydia trachomatis
3. Allergic conjunctivitis - Pollen, perfumes, cosmetics, smoke, dust
4. Chemical conjunctivitis - Acid or alkali's
1. Viral and bacterial conjunctivitis: Viral conjunctivitis and bacterial conjunctivitis
may affect one or both eyes. Viral conjunctivitis usually produces a watery discharge.
Bacterial conjunctivitis often produces a thicker, yellow-green discharge. Both viral
and bacterial conjunctivitis can be associated with colds or with symptoms of a
respiratory infection, such as a sore throat. Both viral and bacterial types are very
contagious. They are spread through direct or indirect contact with the eye secretions
of someone who's infected.
2. Allergic conjunctivitis: Allergic conjunctivitis affects both eyes and is a response to
an allergy-causing substance such as pollen.
3. Toxic conjunctivitis: Toxic conjunctivitis typically occurs with constant use of
topical ocular medications. The reaction may take days to years to develop.
4. Neonatal Conjunctivitis: Neonatal conjunctivitis is occurring in a newborn during
the first month of life, Neonatal conjunctivitis is mainly caused by sexually
transmitted diseases agents such as Chlamydiatrachomatis, Neisseria gonorrhoeae,
and herpes simplex virus (HSV).
Pathophysiology:
Microbes enter the eye on contact with infected objects Inflammation of the eye, Dilatation
of blood vessels of eye, Swelling, redness, exudates and discharge.
Non Pharmacological Management of conjunctivitis:
It's important to stop wearing contact lenses whilst affected by conjunctivitis. It often
resolves on its own, but treatment can speed the recovery process. Allergic conjunctivitis
can be treated with antihistamines. Bacterial conjunctivitis can be treated with antibiotic eye
drops. General treatment can be;
1. Self-care: Cold compress and Artificial tears
2. Supportive care :Can be self-healing
Preventing the spread of pink eye by practicing good hygiene, For instance;
• Don't touch your eyes with your hands.
• Wash your hands often.
• Use a clean towel and washcloth daily.
• Don't share towels or washcloths.
• Change your pillowcases often.
• Throw away your eye cosmetics, such as mascara.
• Don't share eye cosmetics or personal eye care items.
Pharmacological Management of conjunctivitis:
Treatment varies depending on what is causing the inflammation. Bacterial conjunctivitis is
generally treated with antibiotic eye drops or ointment. Viral conjunctivitis does not respond
to antibiotics, but antihistamines and anti-inflammatory medications may help relieve the
symptoms.
Type Symptoms and
Signs
Pharmacological
Management
Prevention
Bacterial
Conjunctivitis
Red eye
Discharge of pus
Pain/Photophobia
(especially if secondary
corneal involvement)
Chloramphenicol 0.5% eye
drops
Gentamicin 0.3% eye drops
Tetracycline 1% eye ointment
Intensive instillation for first
day or until symptoms and
signs reduce
Personal hygiene: hand
washing
correct cleaning and
disinfection of instruments
between examinations
Contact lens hygiene
Viral
Conjunctivitis
Red eye
Watery discharge
Itch/Irritation
Subconjunctival
haemorrhages
Cold compresses to relieve
discomfort
Personal hygiene: hand
washing
correct cleaning and
disinfection of instruments
between examinations
Allergic
Conjunctivitis
Red eye
Lacrimation +++
Itch/Irritation
Reassurance
Antihistamines (eye drops or
orally)
Steroid eye drops
Cromolyn sodium 4% eye
drops
Lodoxamide 0.1% eye drops
Avoid allergens
Glaucoma
Glaucoma is ocular disorder characterized by changes in the optic nerve head (optic disk) and by
loss of visual sensitivity and field. Glaucoma is a ancient Greek word meaning clouded or blue-
green hue. In Hippocratic aphorisms Glaucoma is blindness coming from advancing years it can be
the second leading cause of blindness.
The term ‘glaucoma’ does not represent a single pathological entity. It consists of a large group of
disorders with widely differing clinical features. High intraocular pressure (IOP) was previously
used as a diagnostic criterion for glaucoma, but more recently, it has been recognized purely as the
most important risk factor for the disease. The ‘normal’ IOP (10–21mmHg) is a statistical
description of the range of IOP in the population and is not applicable to an individual subject. It is
thought to increase with age, at the rate of approximately 1mmHg every decade after the age of 40
years.
There are two major types of glaucoma:
1. Normal-pressure chronic open-angle
glaucoma, COAG.
2. Closed-angle glaucoma.
Chronic open-angle glaucoma COAG, also referred to as chronic simple glaucoma, is
associated with a relative obstruction to aqueous outflow through the trabecular meshwork
and is a chronic progressive disease of insidious onset, usually affecting both eyes.
Primary angle-closure glaucoma (PACG), or closed-angle glaucoma, is a condition in
which closure of the angle by the peripheral iris results in a reduction in aqueous outflow.
Clinical Manifestation:
COAG is typically characterized by; an IOP
greater than 21mmHg, an open-angle,
glaucomatous cupping and visual field loss.
Open-angle glaucoma is slowly progressive and
is usually asymptomatic until it has caused a
significant loss of visual field.
In closed-angle glaucoma, patients typically
experience intermittent prodromal symptoms
(e.g., blurred or hazy vision with halos around
lights and occasionally, headache). Acute
episodes produce symptoms associated with a
cloudy, edematous cornea; ocular pain; nausea,
vomiting, and abdominal pain; and diaphoresis.
Pathogenesis:
The primary site of damage is thought to be the optic nerve head, rather than any other
point along the nerve axon.
• In open-angle glaucoma, the specific cause of optic neuropathy is unknown. Increased
intraocular pressure (IOP) was considered to be the sole cause. Additional contributing
factors include increased susceptibility of the optic nerve to ischemia, reduced or
dysregulated blood flow, excitotoxicity, autoimmune reactions, and other abnormal
physiologic processes.
• The risk of visual field loss increases with increasing IOP. IOP is not constant; it
changes with pulse, blood pressure, forced expiration or coughing, neck compression, and
posture.
• Secondary open-angle glaucoma has many causes including exfoliation syndrome,
pigmentary glaucoma, systemic diseases, trauma, surgery, lens changes, ocular
inflammatory diseases, and drugs.
• Many drugs can increase IOP (Table 66-1). The potential to induce or worsen glaucoma
depends on the type of glaucoma and on whether it is adequately controlled.
• Closed-angle glaucoma occurs when there is rise in IOP is caused by a decreased
outflow of aqueous humour, due to closure of the chamber angle by the peripheral iris.
Investigations:
IOP may be measured by tonometry, Tonography is a technique used to measure
the outflow of aqueous humour from the eye, resulting from indentation of the
eye, using a tonometer. Gonioscopy is used to estimate the width of the chamber
angle, with the aid of a slit lamp. Perimetry is important for both the diagnosis
and management of glaucoma by detecting early scotomata and larger changes in
visual field.
Non-Pharmacological Management of Glaucoma:
Glaucoma is treated by lowering your eye pressure (intraocular pressure). Depending on your situation, your
options may include prescription eye drops, oral medications, laser treatment, surgery or a combination of any of
these.
1. Surgery and other therapies: Other treatment options include laser therapy and various surgical procedures.
The following techniques are intended to improve the drainage of fluid within the eye, thereby lowering pressure:
2. Laser therapy. Laser trabeculoplasty is an option if you have open-angle glaucoma. There is use of small laser
beam to open clogged channels in the trabecular meshwork.
3. Filtering surgery. With a surgical procedure called a trabeculectomy, an opening in the white of the eye
(sclera) is created and removes part of the trabecular meshwork.
4. Drainage tubes. In this procedure, your eye surgeon inserts a small tube shunt in your eye to drain away excess
fluid to lower your eye pressure.
5. Minimally invasive glaucoma surgery (MIGS). A MIGS procedure is suggested to lower eye pressure. These
procedures generally require less immediate postoperative care and have less risk than trabeculectomy or
installing a drainage device. They are often combined with cataract surgery.
6. Lifestyle and home remedies: These tips may help you control high eye pressure or promote eye health.
• Eat a healthy diet.
• Exercise safely.
• Limit your caffeine
• Sip fluids frequently.
• Sleep with your head elevated.
• Take prescribed medicine.
Pharmacological Management of Glaucoma:
Chronic open-angle glaucoma: The aim of treatment in COAG is to reduce the raised IOP to the target value,
preventing further damage to the nerve fibres and the development of further visual field defects to maintain the
patient's visual function and quality of life. The key to effective treatment is careful and regular follow-up,
including measurement of visual acuity, tonometry, Gonioscopy, evaluation of the optic disc and Perimetry, which
is of primary importance. The initial treatment of COAG is usually medical. Topical administration is the preferred
type of therapy, and there is a wide range of preparations available.
1. Prostaglandins. These increase the outflow of the fluid in your eye (aqueous humor), thereby reducing your
eye pressure. Medicines in this category include latanoprost (Xalatan), travoprost (Travatan Z), tafluprost
(Zioptan), bimatoprost (Lumigan) and latanoprostene bunod (Vyzulta).
2. Beta blockers. These reduce the production of fluid in your eye, thereby lowering the pressure in your eye
(intraocular pressure). Examples include timolol (Betimol, Istalol, Timoptic) and betaxolol (Betoptic).
3. Alpha-adrenergic agonists. These reduce the production of aqueous humor and increase outflow of the fluid
in your eye. Examples include apraclonidine (Iopidine) and brimonidine (Alphagan P, Qoliana).
4. Carbonic anhydrase inhibitors. These medicines reduce the production of fluid in your eye. Examples
include dorzolamide (Trusopt) and brinzolamide (Azopt).
5. Rho kinase inhibitor. This medicine lowers eye pressure by suppressing the rho kinase enzymes
responsible for fluid increase.
6. Miotic or cholinergic agents. These increase the outflow of fluid from your eye. An example is pilocarpine
(Isopto Carpine).
Therapeutic Category Primary Mechanism
Topical prostaglandins Increase aqueous outflow
Topical prostamides Increase aqueous outflow
Topical β-blocking agents Decrease aqueous formation
Topical miotics Increase aqueous outflow
Topical adrenergic agonists Increase aqueous outflow and decrease aqueous formation
Topical carbonic anhydrase
inhibitors
Decrease aqueous formation
Oral carbonic anhydrase
inhibitors
Decrease aqueous formation
Primary angle-closure glaucoma the medical management of acute PACG is essentially to
prepare the eye for surgical treatment. The aim of treatment is to decrease the IOP and
associated inflammation. Analgesics and antiemetics are sometimes needed, dependent on
symptom severity, to make the patient comfortable.

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Chapter 12 Opthalmology.pptx information

  • 1. CHAPTER 12 Ophthalmology Prepared by Ms. Gunjegaonkar Manjushree B. SJVPM’S Rasiklal
  • 2. LEARNING OBJECTIVES. After studying the chapter, students will be able to:  Understand the Etiopathogenesis of ophthalmic diseases  Explain the subjective and objective features in ophthalmic diseases  Understand rational use of medicine in ophthalmic diseases  Provide well planned procedures of prevention of ophthalmic diseases.
  • 3. Introduction Ophthalmology is a branch of medicine that deals with the diagnosis and treatment of eye disorders. Ophthalmology is the specialized field of medicine that focuses on the health of the eye. It includes the anatomy, physiology and diseases that may affect the eye. Historically, the science of ophthalmology encompassed all aspects of visual function, both in health and in illness. Most common ophthalmic diseases are; • Conjunctivitis • Proptosis (bulged eyes) • Eye tumors • Diabetic retinopathy • Dry eye syndrome • Glaucoma
  • 4. Conjunctivitis The conjunctiva is a thin membrane that covers the inner surface of the eyelid and the white part of the eyeball (sclera).Conjunctivitis is the inflammation of conjunctiva, which makes the white part of the eye appear red Conjunctivitis is an inflammation or infection of the transparent membrane (conjunctiva) that lines the eyelid and covers the white part of the eyeball. When small blood vessels in the conjunctiva become inflamed, they're more visible. This is what causes the white part of the eyes to appear reddish or pink, it is also known as “PINK EYE” It can be caused by allergies or a bacterial or viral infection. Conjunctivitis can be extremely contagious and is spread by contact with eye secretions from someone who is infected. Risk Factors • Exposure to something for which the person have an allergy (allergic conjunctivitis) • Exposure to someone infected with the viral or bacterial form of conjunctivitis • Using contact lenses frequently • Microbial infection (Chlamydia), fungus etc.
  • 5. Clinical manifestation The signs and symptoms and characteristic features of most cases of conjunctivitis are as follows; • Tenderness of the eye, or pain (which can be severe in the cases of irritant conjunctivitis) & Swelling of conjunctiva (chemosis) • Itchiness • Body aches • Photophobia • Redness of the eye or inner eyelids (hyperemia) • Discharge and tear (epiphora) • Drooping of upper eye lid • Periorbital cellulitis • Fever ,Sore throat ,Runny nose • Swelling of the eyelids • Infection usually begins with one eye, but can quickly spread to other eye in cases of viral or bacterial conjunctivitis
  • 6. Etiopathogenesis: 1. Viral conjunctivitis – Adenovirus, HSV 2. Bacterial conjunctivitis – Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenza, Chlamydia trachomatis 3. Allergic conjunctivitis - Pollen, perfumes, cosmetics, smoke, dust 4. Chemical conjunctivitis - Acid or alkali's
  • 7. 1. Viral and bacterial conjunctivitis: Viral conjunctivitis and bacterial conjunctivitis may affect one or both eyes. Viral conjunctivitis usually produces a watery discharge. Bacterial conjunctivitis often produces a thicker, yellow-green discharge. Both viral and bacterial conjunctivitis can be associated with colds or with symptoms of a respiratory infection, such as a sore throat. Both viral and bacterial types are very contagious. They are spread through direct or indirect contact with the eye secretions of someone who's infected. 2. Allergic conjunctivitis: Allergic conjunctivitis affects both eyes and is a response to an allergy-causing substance such as pollen. 3. Toxic conjunctivitis: Toxic conjunctivitis typically occurs with constant use of topical ocular medications. The reaction may take days to years to develop. 4. Neonatal Conjunctivitis: Neonatal conjunctivitis is occurring in a newborn during the first month of life, Neonatal conjunctivitis is mainly caused by sexually transmitted diseases agents such as Chlamydiatrachomatis, Neisseria gonorrhoeae, and herpes simplex virus (HSV). Pathophysiology: Microbes enter the eye on contact with infected objects Inflammation of the eye, Dilatation of blood vessels of eye, Swelling, redness, exudates and discharge.
  • 8. Non Pharmacological Management of conjunctivitis: It's important to stop wearing contact lenses whilst affected by conjunctivitis. It often resolves on its own, but treatment can speed the recovery process. Allergic conjunctivitis can be treated with antihistamines. Bacterial conjunctivitis can be treated with antibiotic eye drops. General treatment can be; 1. Self-care: Cold compress and Artificial tears 2. Supportive care :Can be self-healing Preventing the spread of pink eye by practicing good hygiene, For instance; • Don't touch your eyes with your hands. • Wash your hands often. • Use a clean towel and washcloth daily. • Don't share towels or washcloths. • Change your pillowcases often. • Throw away your eye cosmetics, such as mascara. • Don't share eye cosmetics or personal eye care items.
  • 9. Pharmacological Management of conjunctivitis: Treatment varies depending on what is causing the inflammation. Bacterial conjunctivitis is generally treated with antibiotic eye drops or ointment. Viral conjunctivitis does not respond to antibiotics, but antihistamines and anti-inflammatory medications may help relieve the symptoms. Type Symptoms and Signs Pharmacological Management Prevention Bacterial Conjunctivitis Red eye Discharge of pus Pain/Photophobia (especially if secondary corneal involvement) Chloramphenicol 0.5% eye drops Gentamicin 0.3% eye drops Tetracycline 1% eye ointment Intensive instillation for first day or until symptoms and signs reduce Personal hygiene: hand washing correct cleaning and disinfection of instruments between examinations Contact lens hygiene Viral Conjunctivitis Red eye Watery discharge Itch/Irritation Subconjunctival haemorrhages Cold compresses to relieve discomfort Personal hygiene: hand washing correct cleaning and disinfection of instruments between examinations Allergic Conjunctivitis Red eye Lacrimation +++ Itch/Irritation Reassurance Antihistamines (eye drops or orally) Steroid eye drops Cromolyn sodium 4% eye drops Lodoxamide 0.1% eye drops Avoid allergens
  • 10. Glaucoma Glaucoma is ocular disorder characterized by changes in the optic nerve head (optic disk) and by loss of visual sensitivity and field. Glaucoma is a ancient Greek word meaning clouded or blue- green hue. In Hippocratic aphorisms Glaucoma is blindness coming from advancing years it can be the second leading cause of blindness. The term ‘glaucoma’ does not represent a single pathological entity. It consists of a large group of disorders with widely differing clinical features. High intraocular pressure (IOP) was previously used as a diagnostic criterion for glaucoma, but more recently, it has been recognized purely as the most important risk factor for the disease. The ‘normal’ IOP (10–21mmHg) is a statistical description of the range of IOP in the population and is not applicable to an individual subject. It is thought to increase with age, at the rate of approximately 1mmHg every decade after the age of 40 years.
  • 11. There are two major types of glaucoma: 1. Normal-pressure chronic open-angle glaucoma, COAG. 2. Closed-angle glaucoma. Chronic open-angle glaucoma COAG, also referred to as chronic simple glaucoma, is associated with a relative obstruction to aqueous outflow through the trabecular meshwork and is a chronic progressive disease of insidious onset, usually affecting both eyes. Primary angle-closure glaucoma (PACG), or closed-angle glaucoma, is a condition in which closure of the angle by the peripheral iris results in a reduction in aqueous outflow.
  • 12. Clinical Manifestation: COAG is typically characterized by; an IOP greater than 21mmHg, an open-angle, glaucomatous cupping and visual field loss. Open-angle glaucoma is slowly progressive and is usually asymptomatic until it has caused a significant loss of visual field. In closed-angle glaucoma, patients typically experience intermittent prodromal symptoms (e.g., blurred or hazy vision with halos around lights and occasionally, headache). Acute episodes produce symptoms associated with a cloudy, edematous cornea; ocular pain; nausea, vomiting, and abdominal pain; and diaphoresis.
  • 13. Pathogenesis: The primary site of damage is thought to be the optic nerve head, rather than any other point along the nerve axon. • In open-angle glaucoma, the specific cause of optic neuropathy is unknown. Increased intraocular pressure (IOP) was considered to be the sole cause. Additional contributing factors include increased susceptibility of the optic nerve to ischemia, reduced or dysregulated blood flow, excitotoxicity, autoimmune reactions, and other abnormal physiologic processes. • The risk of visual field loss increases with increasing IOP. IOP is not constant; it changes with pulse, blood pressure, forced expiration or coughing, neck compression, and posture. • Secondary open-angle glaucoma has many causes including exfoliation syndrome, pigmentary glaucoma, systemic diseases, trauma, surgery, lens changes, ocular inflammatory diseases, and drugs. • Many drugs can increase IOP (Table 66-1). The potential to induce or worsen glaucoma depends on the type of glaucoma and on whether it is adequately controlled. • Closed-angle glaucoma occurs when there is rise in IOP is caused by a decreased outflow of aqueous humour, due to closure of the chamber angle by the peripheral iris.
  • 14.
  • 15. Investigations: IOP may be measured by tonometry, Tonography is a technique used to measure the outflow of aqueous humour from the eye, resulting from indentation of the eye, using a tonometer. Gonioscopy is used to estimate the width of the chamber angle, with the aid of a slit lamp. Perimetry is important for both the diagnosis and management of glaucoma by detecting early scotomata and larger changes in visual field.
  • 16. Non-Pharmacological Management of Glaucoma: Glaucoma is treated by lowering your eye pressure (intraocular pressure). Depending on your situation, your options may include prescription eye drops, oral medications, laser treatment, surgery or a combination of any of these. 1. Surgery and other therapies: Other treatment options include laser therapy and various surgical procedures. The following techniques are intended to improve the drainage of fluid within the eye, thereby lowering pressure: 2. Laser therapy. Laser trabeculoplasty is an option if you have open-angle glaucoma. There is use of small laser beam to open clogged channels in the trabecular meshwork. 3. Filtering surgery. With a surgical procedure called a trabeculectomy, an opening in the white of the eye (sclera) is created and removes part of the trabecular meshwork. 4. Drainage tubes. In this procedure, your eye surgeon inserts a small tube shunt in your eye to drain away excess fluid to lower your eye pressure. 5. Minimally invasive glaucoma surgery (MIGS). A MIGS procedure is suggested to lower eye pressure. These procedures generally require less immediate postoperative care and have less risk than trabeculectomy or installing a drainage device. They are often combined with cataract surgery. 6. Lifestyle and home remedies: These tips may help you control high eye pressure or promote eye health. • Eat a healthy diet. • Exercise safely. • Limit your caffeine • Sip fluids frequently. • Sleep with your head elevated. • Take prescribed medicine.
  • 17. Pharmacological Management of Glaucoma: Chronic open-angle glaucoma: The aim of treatment in COAG is to reduce the raised IOP to the target value, preventing further damage to the nerve fibres and the development of further visual field defects to maintain the patient's visual function and quality of life. The key to effective treatment is careful and regular follow-up, including measurement of visual acuity, tonometry, Gonioscopy, evaluation of the optic disc and Perimetry, which is of primary importance. The initial treatment of COAG is usually medical. Topical administration is the preferred type of therapy, and there is a wide range of preparations available. 1. Prostaglandins. These increase the outflow of the fluid in your eye (aqueous humor), thereby reducing your eye pressure. Medicines in this category include latanoprost (Xalatan), travoprost (Travatan Z), tafluprost (Zioptan), bimatoprost (Lumigan) and latanoprostene bunod (Vyzulta). 2. Beta blockers. These reduce the production of fluid in your eye, thereby lowering the pressure in your eye (intraocular pressure). Examples include timolol (Betimol, Istalol, Timoptic) and betaxolol (Betoptic). 3. Alpha-adrenergic agonists. These reduce the production of aqueous humor and increase outflow of the fluid in your eye. Examples include apraclonidine (Iopidine) and brimonidine (Alphagan P, Qoliana). 4. Carbonic anhydrase inhibitors. These medicines reduce the production of fluid in your eye. Examples include dorzolamide (Trusopt) and brinzolamide (Azopt). 5. Rho kinase inhibitor. This medicine lowers eye pressure by suppressing the rho kinase enzymes responsible for fluid increase. 6. Miotic or cholinergic agents. These increase the outflow of fluid from your eye. An example is pilocarpine (Isopto Carpine).
  • 18. Therapeutic Category Primary Mechanism Topical prostaglandins Increase aqueous outflow Topical prostamides Increase aqueous outflow Topical β-blocking agents Decrease aqueous formation Topical miotics Increase aqueous outflow Topical adrenergic agonists Increase aqueous outflow and decrease aqueous formation Topical carbonic anhydrase inhibitors Decrease aqueous formation Oral carbonic anhydrase inhibitors Decrease aqueous formation Primary angle-closure glaucoma the medical management of acute PACG is essentially to prepare the eye for surgical treatment. The aim of treatment is to decrease the IOP and associated inflammation. Analgesics and antiemetics are sometimes needed, dependent on symptom severity, to make the patient comfortable.