Glaucoma is a group of eye diseases that damage the optic nerve and can cause vision loss. It is usually caused by an increase in pressure within the eye due to blocked drainage canals. There are two main types - open angle glaucoma caused by partial blockage and closed angle glaucoma caused by sudden, complete blockage. Treatment aims to lower intraocular pressure through eye drops, oral medication, laser therapy or surgery depending on the severity. Surgical treatment is usually a last resort but is the primary approach for closed angle glaucoma emergencies. Post-operative care involves anti-inflammatory and antibiotic eyedrops.

1. GLAUCOMA

2. GLAUCOMA
Glaucoma : is a group of eye diseases in which the optic
eye nerves is damaged leading to irreversible loss of
vision, in the most cases this damage is due to increase
pressure within the eye .

3. GLAUCOMA
caused by :
- increased intraocular pressure / ocular hypertension
(high pressure of fluids "aqueous humor" within the
eye),
complication:
- possible optic nerve damage.

4. liquid aqueous humor:
produced by ciliary bodies, flows into
posterior chamber, flows through pupil,
flows into anterior chamber, drained by
trabecular meshwork.

5. In a healthy eye the rate of secretion is balanced with
the rate of drainage.
In glaucoma, the drainage canal is partially or
completely blocked, fluids build up in the eye chamber
leading to increased pressure.

6. GLAUCOMA
There are two type of glaucoma open angel and closed
angle glaucoma .
Open angle glaucoma (chronic glaucoma) is caused by
partial blockage of the drainage canal .
Closed angle glaucoma ( acute glaucoma )is caused by
sudden or complete blockage of aqueous humor
drainage the pressure within the eye.

8. GLAUCOMA
open /wide-angle glaucoma
1) degeneration & obstruction of trabecular meshwork.
2)reducing drainage of aqueous humor
3)increased resistance & chronic buildup of pressure in the
eye.
close/narrow-angle glaucoma
1)complete closure of iridocorneal angle.
2)reducing flow of aqueous humor from posterior chamber
to anterior chamber.
3)increased resistance & acute pressure in the eye.

9. -The aim is to lower intra-ocular pressure
-Topically (B-blockers, parasympathomimetics)
OR systemic (carbonic anhydrase inhibitors, osmotic diuretics)
-First line therapy: B-blocker, prostaglandin analoges, alpha 2
agonist and carbonic anhydrase inhibitor .

10. Treatment of open angle glaucoma
B-blockers:
 First choice of treatment.
 MOA: block beta receptors in the
ciliary epithelium and reduce the
secretion of aqueous humour.
 Side effects: bradycardia, headache,
dyspnea.

11. Treatment of open angle glaucoma
prostaglandin analoges:
 Are used topically to lower intra-ocular pressure.
 Examples: travoprost , bimatoprost , latanoprost .
alpha 2 agonist:
 Example : brimonidine .

12. Treatment of open angle glaucoma
Carbonic anhydrase
inhibitors :
 Used with the previous
medications.
 MOA: reduce production
of aqueous humour.
 Side effects: confusion,
drowsiness, nausea.

13. Treatment of open angle glaucoma
parasympathomimetics:
 MOA: facilitate ocular
drainage by constricting
the pupil and pulling open
the meshwork.
 Side effects: blurred vision,
brow ache, itching.
 Pilocarpine eye drop
 carbachol

14. Treatment of open angle glaucoma
 Eye drops contain tow
medications.

15. Treatment of closed angle glaucoma
 Should be started within 24 -48 hours .
 If it is delayed :
- adhesion may form between the iris and the cornea.
- the ocular meshwork may be damaged.
- leads to chronic closed angle glaucoma then loss
vision (absolute glaucoma).

16. Treatment of closed angle glaucoma
 parasympathomimetics : e.g. pilocarpine.
 carbonic anhydrase inhibitors : e.g. acetazolamide.
 osmotic diuretics : e.g. mannitol and urea (IV),
glycerol or isosorbide (orally).
 prostaglandin : which is used topically to lower intra-
ocular pressure.

17. Treatment of closed angle glaucoma
Osmotic diuretic :
 Used in the short-term management of glaucoma prior
to surgery.
 MOA: reduce vitreous volume and cause marked
reduction in intra-ocular pressure.
 Side effects: oral dryness, ocular dryness, headache,
dizziness.

18. - Usually we start with the non-surgical treatment if it
was not effective, we go to laser therapy and lastly we
go to surgical treatment.
- But in emergency cases (closed-angle glaucoma) the
surgery is the first choice.

19. Surgical treatment of glaucoma
Patient who have had a previous ocular surgery there is a
high failure rate, due to formation of scar tissue.
We can give injection of anti-proliferative agent such as
fluorouracil, that has been shown to reduce the failure
rate of surgery. (S/E: increased epithelial toxicity and
conjunctival wound leaks).

20.  After the surgery we give antibacterial and anti-
inflammatory drugs, on the afternoon of the same day
of the surgery , we measure the ocular pressure and if
we observe that the pressure started to rise (20 mmHg
instead of 15 mmHg), we give anti-glaucoma drug, but
we have to be careful not to mix them with the post-
operative drugs, we give them in different times. OR
we give Diamox® tablets after the surgery as an anti-
glaucoma agent.
Surgical treatment of glaucoma

21.  Anti-bacterial agents:
 Dexacol®: eye drops
(Chloramphenicol,Dexamethasone)
Steroidal antibacterial drug.
 Zymar®: ophthalmic solution
(Gatifloxacin-fluoroquinolone):
Antibacterial that is active against
pathogens that are resistant to other
antibiotics.
Post-operative agents

22.  Anti-inflammatory agents:
 Nevanac® (Nepafenac 0.1%):
non-steroidal anti-inflammatory drug
(NSAID).
 Pred Forte® (Prednisolone acetate):
steroidal anti-inflammatory drug.
Surgical treatment of glaucoma

23.  Martindale, The extra
pharmacopoeiua, the
thirty-first edition.
Referances

24. By:
Laila Falana
Hadeel Abu Mhameed
Reem Aqtash