Glaucoma

1. GLAUC MA

2.  Anatomy Of The Eye

3.  Physiology

4.  Flow Of Aqueous
Production : Ciliary
Body
Secreted Into
Posterior Chamber
Via Pupil Anterior Chamber
Angle Of Anterior
Chamber
(Iridocorneal angle)
Uveoscleral Outflow Supraciliary Space
Trabecular
Meshwork
Schlemm's Canal

5.  Pathology
• Definition : Glaucoma refers to group of diseases with
progressive and characteristics Optic disc changes, leading to
irreversible Visual field changes, which may or may not be
associated with increased IOP (Normal = 11 – 21 mmHg)
• Glaucoma is seen in two clinical forms i.e. Open angle (Chronic
simple glaucoma) and Angle closure (Acute congestive glaucoma)

8. Open Angle ( Chronic Simple
Glaucoma )
Problem in drainage
Chronic condition
Seen in elderly
Headache
Peripheral visual field loss
Delayed dark adaptation
Frequent change of Presbyopic glasses
IOP > 21mmHg
Angle Closure (Acute Congestive
Glaucoma)
Problem in flow
Acute condition
Seen in young adults
Severe headache
Severe eye pain
Nausea/Vomiting
Blurring of vison
IOP > 40mmHg

10.  Pharmacotherapy
AIM
Decrease
the
formation
of Aqueous
Facilitate the
Uveoscleral
outflow
Facilitate the
drainage via
Trabecular
meshwork
Draw fluid
from the eye
into the
circulation

11.  Drugs
1. PGF2α analogues
• Latanoprost/Bimatoprost/Travoprost
• M.O.A : Increase Uveoscleral outflow
• Route : Topical
• S/E : Hyperpigmentation of Iris, Hypertrichosis,
Uveitis, Macular Edema .
*Drug Of Choice
( Bimatoprost is FDA approved drug for Hypotrichosis )

12. 2. β-Blockers
• Timolol/Betaxolol/Levobunolol
• M.O.A : Reduces the Aqueous formation by blocking the β2
receptors in the Ciliary blood vessels
• Route : Topical
• Ocular S/E : Blepharoconjuctivitis, NLD Blockage,
Corneal Anesthesia (Propranolol)
• C/I : Arrythmia
Bronchospasm
Congestive Heart Failure
Diabetes Mellitus

13. 3. α-Agonists
• Dipiverfin/Apraclonidine/Bromidine
• M.O.A : Decreases aqueous formation by acting on α2 receptors in
Ciliary blood vessles
Dipiverfin is a prodrug of Adrenaline, It acts on α1 receptors and causes
vasoconstriction and acts on β-receptors and Increases Uveoscleral and
Trabecular outflow.
• S/E : Follicular conjunctivitis, Eyelid retraction ( Apraclonidine )
Drowsiness, Depression, Apnea ( Bromidine )

14. 4. Carbonic anhydrase inhibitors
• Acetazolamide/Brinzolamide/Dorzolamide
• M.O.A : Inhibit C.A enzyme thereby decreasing the formation of Aqueous
• S/E : Hypokalemia/ Acidosis/ Anorexia (Acetazolamide)
Ocular stinging, burning, itching etc. (Dorzolamide)

15. Acute attack of Glaucoma
• It is an Ophthalmological emergency precipitated by mydriasis (Dim light).
• Presenting symptoms include severe eye pain, redness, blurred vision, seeing
haloes around lights, and nausea and vomiting.
• Intraocular pressure (IOP) is usually very high (>40 mm Hg).
• On eye examination :

16. Treatment : Reduce IOP Immediately
Step 1 – I.V Mannitol 500ml Of 20% Solution, 1-2gm/Kg Infused
Over 30 Min
Or Tab Acetazolamide 500mg Stat.
Step 2 – Pilocarpine eye drops (2-4%)
Step 3 – Laser Iridotomy i.e. Creation of hole in Iris.