Review module 7

• What is Primary open-angle glaucoma?

  progressive, painless, insideous

  progressive optic nerve damage with impairment of vision

  vision loss develops first in periphery then central
• how is POAG treated?

  facilitating aqueous outflow or reducing production
• what is the first line treatment for POAG?

  beta blockers, alpha-adrenergic agonist, prostaglandins
• what is the second line treatment for POAG?

  cholinergic drugs and carbonic anhydrase inhibitors
• what is angle closure glaucoma?

  displacement of iris that it covers trabecular meshwork, preventing exit of humor from anterior chamber

  IOP increases rapidly

  angle between cornea and iris is reduced
• what is the treatment for angle-closure glaucoma?

  drug therapy to control acute attack

  surgery
• what combination therapy to control acute closure glaucoma?

  osmotic agents, short-acting miotics, carbonic anhydrase inhibitors, topical beta blockers
• what 5 beta blockers approved for glaucoma?

  betaxolol

  carteolol

  Levobunolol

  Metipranolol

  Timolol
• how does beta blockers lower IOP?

  decrease production of humor
• what is the only selective ophthalmic beta blocker?

  Betaxolol
• what are the 5 prostaglandins for glaucoma?

  Lantanoprost (Xalatan)

  Travoprost

  Bimatoprost

  Lantanoprostene bunod

  tafluprost
• how does Latanoprost lower IOP?

  facilitates outlow of IOP by relaxing ciliary muscle
• what is the most significant side effect of Lantanoprost?

  heightened brown pigmentation of the iris

  rare in blue, green, or blue/green

  most notice able in: green-brown, yellow-brown, blue/gray brown
• When does latanoprost stop heightened pigmentation?

  once discontinued but does not regress
• how does Latanprost effect the eye and eyelid?

  heightened pigmentation on eyelid

  increase thickness, length, and pigmentation of eyelashes
• which prostaglandin is most effective in blacks?

  Travoprost
• which prostaglandin is marketed to help eyelash length, thickness, and darken?

  Bimatoprost (Latisse)
• what are two alpha agonist for glaucoma?

  apraclonidine and brimonidine
• which alpha agonist is used for short term and long term?

  short - Apraclonidine

  long - Brimonidine
• how does Brimonidime and Apraclonidine lower IOP?

  Decreases aqueous humor production and possibly outflow
• how does alpha agonist prevent retinal neuron death that delay optic nerve degeneration?

  protect neurons from injury causing by ischemia
• how does Brimonidine differ from Apraclonidine?

  Brimonidine can cross the BBB and cause drowsiness, fatigue and hypotension
• Apraclonidine uses

  short term therapy in open angle glaucoma who have not responded to max doses of other IOP drugs

  preop before laser therapy
• what are two fixed doses available for glaucoma or lowering IOP?

  brimonidine/timolol

  Brimonidine/Brinzolamide (Simbrinza)
• Pilocarpine lower muscarinic effects

  miosis (constriction) and contraction of ciliary muscle (focuses for near vision)
• How does Pilocarpine work with open angle vs angle closure glaucoma?


  open: IOP lowered indrectly by tension of ciliary muscle promotes widening of meshwork allowing outflow

  angle: contraction of iris pulls away from mesh work removing impediment of outflow
• what cholinesterase inhibitor is approved for POAG and reserved for who

  Echothiophate

  reserved for pts that responded poorly to first line treatments
• what is greatest concern using Echothiophate?

  developing cataracts
• what systemic effects can Echothiophate produce?

  Bradycardia, bronchospasms, sweating, salivation, urinary urgency, diarrhea
• what are the two carbonic anhydrase inhibitors? lower IOP?

  Dorzolamide and Brinzolamide

  decreasing the production of humor
• what education should you advise when using Brinzolamide and Dorzolamide?

  both contain benzalkonium chloride which can be absorbed by soft contacts

  wait 15 minutes after admin before putting in contacts
• what are the two oral carbonic anhydrase inhibitors? lower IOP?

  acetazolamide and Methazolmide

  lower by decreasing production of humor
• main concern with oral carbonic anhdryase inhibitors?

  CNS, GI disturbances, teratogenic in animals - avoid in first trimester

  acid/base disturbances, electrolyte imbalances, and nephrolithiasis
• How does Netarsudil lower IOP?

  increasing humor outflow through tubular meshwork
• what is allergic Conjunctivitis?

  inflammation of conjunctiva response to allergen either seasonal or perennial (chronic)

  symptoms peak about 20min after exposure and abate 20min later, reappear >6 hours later
• what drugs can help treat allergic conjunctivitis?

  mast cell stabilizers (cromolyn and lodoxamide) - take days to weeks to be effective

  histamine 1 receptor antagonist

  Ketorolac

  glucocoroticoids

  ocular decongestants
• what drug is an artificial tears for dry eyes due to inflammation?

  Topical cyclosporine ophthalmic emulsion (Restasis)
• what are ocular decongestants to constrict dilated conjunctival BV (adrenergic)?

  phenylephrine

  naphazoline

  oxymetazoline

  brimonidine

  tetrahydrozoline
• what long term effects of glucocorticoids on the eye?

  cataracts, reduced visual acuity, glaucoma

  secondary infection
• what are two antiviral medications for the eye?

  Trifluridine and ganciclovir