Glaucoma is an eye disease that is often associated with elevated intraocular pressure, in which damage to the eye (optic) nerve can lead to loss of vision and even blindness. Glaucoma is the leading cause of irreversible blindness in the world.

1. Presented by
Ved prakash panda
M.Pharm (pharmacology)

2.  Introduction
 Epidemiology
 Aetiology
 Pathophysiology
 Clinical menifestation
 Diagnosis
 Treatment

3.  Definition :glaucoma is a type of eye disorder in
which the optic nerve is damaged due to increase
in intraocular pressure with in the eye.
 The eye produce a fluid called aqueous humor,
which is secreted by cilliary body, into the
posterior chamber(a space between the iris and
the lens),it then flows in to the anterior chamber
between the iris and the cornea.
 From here it drains through a sponge like
structure located at the base of the iris called the
trabecular meshwork and leave the eye through
venous circulation.

6. 1. OPEN ANGLE GLAUCOMA
2. CLOSED ANGLE GLAUCOMA
Epidemiology:
2% of people older than 40 years have
open angle glaucoma and rises to almost 10%
in people older than 75 years.
Aetiology:
In a healthy eye, the rate of secretion
balance the ratio of drainage. In people with
glaucoma, the drainage canal is partially or
completely blocked. Fluid builds up in the
chamber and this increase pressure with in the
eye, causing intraocular hypertension, which is
defined as pressure > 21 mm Hg.

7.  The primary site of damage is the optic nerve
leading to loss of vision.
 In open angle glaucoma, the angle between
the cornea and iris is open.
 In this type the drainage system slowly get
clogged overtime and thus gradual increase
in pressure on optic nerve, results in dec. of
peripheral vision, as the pressure increase
even more, continious damage to opticnerve,
which eventually leads to loss of central
vision.

9.  In closed angle glaucoma the angle between
the iris and cornea is too small, that means
the passage way for aqueous humor outflow
is too narrow and this is result of lens been
pushed against the iris, result of this leads to
blockage of drainage system.
 This is most serious type of glaucoma in
which rapid pressure build up in the eye
which can cause onset of eye pain and
redness, blurry vision, headache.
 This may occur due to dilation of lens or
pupil which cause the iris pushing forward
and close the angle.

11.  Glaucoma is typically characterised by:
 IOP > 21 mmHg
 Visual field loss
 Glaucomatous retinal nerve damage
 Glaucomatous cupping (Increase in IOP
pushes the optic disc back forming an cup
size).
 In close angle glaucoma the pressure lies
between 50 to 80 mm Hg. And cause cornea
oedema.
 The pupil is vertically oval & un reactive to
light and accommodation.

12.  Tonometry : measure intraocular pressure.
 Tonography: measure the outflow of aqueous
humour from the eye.
 Gonioscopy: is used to estimate width of the
anterior chamber angle.
 Perimetry: diagnosis of scotoma (blind spot).
 Visual field testing
 Loking for optic nerve damage, glaucomatous
cupping by imaging.

13.  PHARMACOLOGICAL TREATMENT:
 Main goal of drug is to decrease the pressure in
the eye.
 Increase out flow of the aqueous humor
 Prostaglandin analogues:
 prostaglandins increase the sclera permeability
to aqueous fluid so, an increase in PG activity
increase out flow of aqueous fluid, thus
lowering intra ocular pressure.
 Drugs:
 Latanoprost
 Travaprost
 Bimatoprost

14.  Decrease production of aqueous humor:
 Beta- blockers: they decrease IOP by
blockage of ciliary B-receptor, preventing
the cyclic AMP induced rise in aqueous
secretion.
 Drugs: Betaxolol, Timolol.
 Sympathomimet agents:
 Adrenaline is an alpha & beta
adrenoreceptor agonist. It decrease IOP by
redeucing aqueous inflow via an alpha
mediated vasoconstriction in the ciliary
body & increase outflow due to beta
mediated dilation of the episcleral veins.
 Drygs used are: Apraclonidine, Brimonidine.

15.  Carbonic anhydrase inhibitors:
 Carbnic anhydrase present with in the ciliary
epithelial cells generate HCO3 ion whch is
secreted into aqueous humor and it’s
inhibitors inhibit this aqueous humor
production.
 Drugs : Acetazolamide, Dorzolamide.
 Miotics:
 Miotics act to increase the outflow of
aqueous humor by a stimulation of ciliary
muscle and on opening of channels in the
trabecular meshwork.
 Drugs: pilocarpine.

16.  Hyper osmotic agents:
 This agents acts by drawing water out of the eye,
thus lowering intra ocular pressure.
 Drugs: glycerol, mannitol.
 COMBINATION THERAPY:
 Fixed combination of timolol &dorzolamide
Timolol-0.5% Dorzolamide2%
 Combination of timolol and lantanoprost
Timolol0.5%,latanoprost0.005% (xalacum)
 Combination of timolol and brimonidin
Timolol0.5% brimonidin0.2%
 Combination of timolol & travoprost
Timolol0.5% travoprost0.004%
 Combination of timolol & bimatoprost
Timolol 0.5% bimatoprost 0.03%