1. Glaucoma
Definition
Progressive optic neuropathy
Characteristic optic disc
appearance
Irreversible visual field
defects
Associated with an increased
IOP (Intra ocular pressure)
Classification
Congenital glaucoma
Developmental
Primary
Primary open angle
Primary angle closure
Chronic
Acute
Low lighting conditions
Females
> 50 years
Small eyes
Hypermetropic eye
Secondary
Anatomy of the eye
Anterior Segment
Posterior chamber
Anterior chamber
Cornea
Posterior Segment
Sclera
Uvea
Layers of retina
Vitreous body
Aqueous humour
Production (Ciliary epithelium)
carbonic anhydrase
ß 2 receptors
α 2 receptors
Drainage
uveo-scleral veins
trabecular meshwork
Pathogenesis
Pressure related block in
neurotrophin transport to
RGCs
Pressure independent factors
Excito-toxicity
Drugs that increase outflow
prostaglandin analogues
travaprost
bimatoprost
unoprostone
Latanoprost
parasympathomimetics
cycloplegia, brow pain
short duration of action
echothiophate
pilocarpine
adrenergic agonists
also decrease production
dipivefrin
epinephrine
Drugs that decrease
production
carbonic anhydrase inhibitors
topical
brinzolamide
dorzolamide
systemic
high risk of S/E
acetazolamide
ß blockers
caution: Asthma, COPD & heart failure
considered to be first line
therapy glaucoma
betaxolol
carteolol
Levobunolol
timolol
α 2 agonists
preferred for short term
treatment (post operative)
brimonidine
apraclonidine