this covers almost all important notes about glaucoma and its pharmacological aspects. Credit : Prabhat Kumar shantanu Nishan lamichhane

1. GROUP- “F”
PRESENTS

2. GLAUCOMA
 GLAUCOMA IS A DISEASE THAT CAUSES DAMAGE
TO THE EYE.
 THIS DISEASE HAPPENS BECAUSE OF INCREASED
PRESSURE IN THE EYE. THE PRESSURE CAUSES
DAMAGE TO THE OPTIC NERVE.

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6. WHAT CAUSES GLAUCOMA ?
1. The clear fluid inside the eye is produced by the ciliary body
2. This fluid, known as aqueous humour, flows behind the iris. The
aqueous humour fills the anterior chamber, a space between back
of cornea and front of iris
3. The fluid exists the eye through the structure known as the drainage
angle(Schlemm’s Canal), which is formed inside the anterior the
anterior chamber between iris and cornea.
4. The aqueous filters through this angle and through the sclera or
white part of the eye and then joins with the network of veins
outside the eye
5. Any disruption of this outflow of aqueous – including form certain
eye injuries – can result in an increase in Intra Ocular pressure
(I.O.P.) 6

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8. TYPES OF GLAUCOMA
A. Open Angle (Wide angle, Chronic simple)
Glaucoma
B. Angle Closure (Narrow angle, Acute congestive)
Glaucoma
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9. A. OPEN ANGLE (WIDE ANGLE, CHRONIC
SIMPLE) GLAUCOMA
• It is the most common type.
• The drain structure in the eye – it is called
trabecular meshwork – looks normal, but the
fluid dosen’t flow out like it should
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10. B. ANGLE CLOSURE (NARROW ANGLE, ACUTE
CONGESTIVE) GLAUCOMA
• It is less common type
• Eye doesn't drain right because the drain
space between iris and cornea become too
narrow
• This can cause a sudden buildup of pressure
in our eye
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12. ANTI-GLAUCOMA DRUGS
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External application of the
drug on the surface i.e. skin
or mucous membrane of
eye for localized action

13. DRUGS USED IN GLAUCOMA
DECREASE AQUEOUS
PRODUCTION
OCULAR BETA BLOCKERS
1. Timolol (Topical)
2. Betaxolol (beta)
3. Levobunolol (Bl….)
4. Carteolol (….ckers)
ALPHA 2-SELECTIVE AGONIST
1. Apraclonidine
2. Brimonidine
CARBONIC ANHYDRASE
INHIBITOR
1. Acetazolamide
2. Brinzolamide
3. Dorzolamide
INCREASE AQUEOUS
OUTFLOW
INCREASE TRABECULAR
OUTFLOW
INCREASE
UVEOSCLERAL
OUTFLOW
NONSELECTIVE ALPHA
AGONIST
1. Epinephrine
2. Dipivefrine - prodrug of
epinephrine
CHOLIMIMETIC DRUGS
1. Pilocarpine - direct
2. Physostigmine - indirect
3. Echothiophate -indirect
PROSTAGLANDIN
ANALOGUES
1. Latanoprost
2. Bimatoprost
3. Tafluprost

14. ALPHA ADRENERGIC AGONIST
Adrenergic Alpha 1:- vasoconstriction of ciliary muscles
Adrenergic Alpha 2:- Reduce action of ciliary epithelium
activity
Examples : Dipivefrine, Apraclonidine, Brimonidine.
Dipivefrine :- It is a prodrug of ADR; penetrated cornea and
is hydrolyzed by the esterase present there into ADR which
lowers IOT by augmenting uveoscleral outflow.
Apraclonidine :- it decreases aqueous production by
primary alpha 2 and subsidiary alpha 1 action on ciliary
body
Brimonidine :- it is more Alpha 2 selective and more lipofilic
than Apraclonidine. It lowers I.O.T. by reducing aqueous
production and by increasing Uveosclereal flow
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16. BETA ADRENERGIC BLOCKERS
 Beta 2 adrenoreceptors located on ciliary epithelium enhance
aqueous secretion by a increased cAMP and they are blocked by
Timolol / Betaxolol.
 Beta blockers reduce the I.O.P by blockade of sympathetic nerve
ending in the ciliary epithelium causing a fall in aqueous humor
production
 Timolol :- it is the prototype of ocular beta blockers it is non
selective (β1 + β2)
 Betaxolol :- it is a β1 selective blocker offering the advantage of
less bronchopulmonary and probably lee cardiac central and
metabolic side effects. However it is less efficious in lowering I.O.T.
than timolol because, ocular beta receptors are predominantly of
the β2 subtype.
 Most opthmalogist prefer to start with betaxolol and change over
to timolol if there is insufficient control or local intolerance to
betaxolol 16

17. CONTINUED
Side effects are
1. Ocular side effect
Stinging(smoke stinging/burning sensation),
redness, dryness of eye, corneal
hypoesthesia(decrease in sensation), blur
vision.
2. Systemic side effect
Bronchospasm, bradycardia ( decrease heart
rate)
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18. PROSTAGLANDIN ANALOGUE
It act by increasing Uveoscleral outflow, possibly by
increasing permeability of tissues in ciliary muscles or by
an action on episcleral vessels(clear layer on top of the
white part of eye, outside which conjunctiva is present.
Example : Latanoprost, Travoprost, Bimatoprost.
Latanoprost
It is the 1st choice drug for open angle
glaucoma because of
• Good Efficacy (maximum response of drug)
• Once daily Application
• Absence of systemic complication
Bimatoprost
It is equally effective as Latanoprost how ever
it has more side effects
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20. CARBONIC ANHYDRASE INHIBITORS
MOA
It work by inhibiting carbonic anhydrase
(isoenzyme II), which is found in ciliary body
epithelium. This reduces the formation of
bicarbonate ions, which reduces fluid transport,
reducing fluid I.O.P
Example Acetazolamide, Dorzolamide
Acetazolamide
It is given Orally
 Dorzolamide
It is given Topically (external application of the
drug on the surface i.e. skin or mucous
membrane of eye for localized action) 20

21. MIOTICS
These reduce eye pressure by increasing the
drainage of intraocular fluid through the trabecular
meshwork i.e by increasing ciliary muscle tone
These drugs especially Pilocarpine previously were
the standard antiglaucoma drug
However, because of several drawbacks, they are
used only as THE LAST OPTION.
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 Start monotherapy with Latanoprost / another PG Analogue / Topical beta blocker
If target I.O.T. is not attained,
 Either change over to the alternative drug or use both above concurrently (at the same time) .
When there are contraindication to PG analogues and/or beta blockers or to
supplement their action
 Brimonidine / Dorzolamide (occasionally Dipivefrine) are used
 Topical miotics and Acetazolamide are added (used as the last Option)

24. ANGLE CLOSURE
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Vigorous therapy employing several measures to reduce I.O.T.
Hypertonic mannitol
Acetazolamide
Miotic
Tropical beta blockers
Apraclonidine 1% (/Latanoprost 0.005%)
NOTE
These drugs are used only to terminate the attack of angle closure glaucoma
Definitive treatment is surgical or laser peripheral iridotomy (standard first-line
treatment)
These may be treated with these drugs for long periods, but often surgery or laser
therapy is ultimately required.

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26. TEAM
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PRABHAT KUMAR
SHANTANU NISHAN LAMICHHANE NEHA GHIMIRE NISHANT KHAKUREL

27. TEAM
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NISHIKA SHAH NEHA PRABHA CHATURVEDI NASREEN

28. TEAM
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NISHA RAJ PRAKRITI ADHIKARI

29. THANKYOU
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