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Therapeutic Management of Glaucoma

Introduction
•Glaucoma is an eye disease in which the optic nerve is damaged in a characteristic pattern.
•This can permanently damage vision in the affected eye(s) and lead to blindness if left untreated.
•It is normally associated with increased fluid pressure in the eye (aqueous humour).

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Pathophysiology and Etiology of Glaucoma
•Of the several causes for glaucoma, ocular hypertension (increased pressure within the eye) is the most important cause in most glaucomas, but in some populations, only 50% of people actually have elevated ocular pressure.
•Intra-ocular pressure rises when there is an imbalance between production and drainage of aqueous humour in the eye.

Risk factors
•Old age
•Family history of glaucoma
•Thinner central corneal thickness
•Raised intra-ocular pressure is an important risk factor for glaucoma

Classification of glaucoma
Glaucoma is classified as open-angle or angle-closure depending on the mechanism of the obstruction of drainage.

May also be
•acute or
•chronic.

1. Open angle glaucoma

The most common form of glaucoma is chronic open-angle glaucoma ( also known as simple glaucoma; wide-angle glaucoma) which is due to blockage in drainage through the trabecular meshwork.

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2. Angle closure glaucoma

•In contrast to open angle glaucoma, angle-closure glaucoma (closed-angle glaucoma; narrow-angle glaucoma) usually occurs as an acute emergency.

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Signs and symptoms of Open – angle Glaucoma
1. gradually progressive visual field loss
2. optic nerve changes.
however, It is painless and does not have acute attacks.

Signs and symptoms of Closed-angle glaucoma
1.ocular pain
2.seeing halos around lights
3. red eye
4.very high intraocular pressure (>30 mmHg)
5. nausea and vomiting
6.suddenly decreased vision, and
7.fixed, mid-dilated pupil

Aim of management of glaucoma
•The aim is not just to reduce intra-ocular pressure to a normal value but to a level at which damage to the optic nerve ceases.
•Many ophthalmologists consider that therapy is indicated if the intra-ocular pressure is higher than 30 mmHg. Normal range (15-21mmHg).

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Antiglaucoma drugs

1. Beta-blockers
2. Prostaglandin analogues
3. Miotic agents
4. Sympathomimetics
5. Alpha2-adrenoceptor agonist
6. Carbonic anhydrase inhibitors
7. Osmotic diuretics

(1) Beta blockers

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(2) Prostaglandin analogues

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(3) Miotic agents

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(4) Sympathomimetics

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(5) Alpha2-adrenoceptor agonist

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(6)Carbonic anhydrase inhibitors

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Osmotic diuretics

Osmotic diuretics reduce vitreous volume and can produce a marked reduction in intra-ocular pressure.
They are used in the short-term management of glaucoma when a rapid reduction in intra-ocular pressure is required before surgery.
Mannitol and urea are both given intravenously and have a fast onset than glycerol or isosorbide given orally.

Others
Marijuana was found, in the early 1970s, to reduce pressure in the eyes, though how the cannabinoids in marijuana produce this effect remains unknown.
However, If these are unsuccessful, surgery (trabeculectomy) or laser treatment (trabeculoplasty) is usually indicated.

Pharmacists’ role

Instruct patients in aseptic technique to prevent contamination of the container and product, and ultimately the eye.
Instruct patients in aseptic technique to prevent contamination of the container and product, and ultimately the eye.
If different ophthalmic formulations are being used, solutions should always be used before other formulations, such as gels and suspensions, to optimize absorption of each medication.

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7 comments

  1. nice piece of.work…really enthralled but I would suggest that the carbonic anhydrase inhibitor should be looked into because I somehow it to be acetazolamide..thanks..and kip it up

  2. Thx for dis lesson, u really reminded me of some many things.

  3. wondeRful uPdates.keep it up keep it real.

  4. Nice info. Found similar info on
    http://www.southcaleye.com/glaucoma/glaucoma-specialist-orange-county/

    Could you give some info about cataract surgeries and their post effects.

  5. nice one. thanks for the update, was educating

  6. I am 50 years old male and went to Orange County for the cataract surgery last winter and early spring. First one eye and then the next. The surgery was performed as an outpatient at the hospital. The surgery was simple and painless. I could tell they were messing around with my eyes, but there was really no pain. My vision improved almost immediately and within a week. I was seeing the brilliance of colors and details like I had remembered. Five months later I am so pleased as I could be, my vision is excellent.