1 - Glaucoma

Front 1

What is normal IOP?

What is IOP in glaucoma?

Back 1

normal IOP is 10-20 mmHg

IOP in glaucoma > 22 mmHg

Front 2

How does the IOP in pts with glaucoma occur?

Back 2

Aqueous humor is constantly produced by the ciliary body,

This fluid then flows through the pupil and leaves the eye through tiny channels called the TRABECULAR mesh work,

then the AH travels through tiny blood vessels and reenters the main blood stream,

if the TRABECULAR mesh work gets plugged, or damaged, then the AH backs up into the eye and increases the pressure of the VITREOUS HUMOR,

this increase in pressure presses against the OPTIC NERVE and over time damages the nerve IRREVERSIBLY causing blindness.

Front 3

What is the most common form of glaucoma?

Explain

Back 3

Open-angle glaucoma which is chronic

fluid drains through the drainage angle of trabecular mesh work too slowly and eventually gets backed up with a gradual, persistent increase in IOP. The angle between the structures appears normal or open.

Front 4

What is the other type of glaucoma?

Back 4

Angle-closure glaucoma - acute

Drainage from the eye becomes physically block an already narrowed angle of exit. This traps fluid in the eye increasing IOP.

Acute angle closure glaucoma is a medical emergency and must be treated immediately to prevent vision loss/blindness.

Front 5

What is secondary glaucoma?

Back 5

this type develops secondary to another medical condition such as a tumor, inflammation, DIABETES, eye injury, long-term corticosteroid therapy.

Front 6

What determines IOP?

What is used to measure the angle?

What is ophthalmoscopy or fundoscopy?

Back 6

Tonometry

Gonioscopy

ophthalmoscopy and fundoscopy is when the DR uses a hand held device to look thru the pupil to visually examine the optic nerve and blood vessels in the back of the eye.

Front 7

What are some serious symptoms of glaucoma?

other symptoms?

Back 7

SERIOUS SYMPTOMS
decreased vision
sore, red eyes
swollen eyelids
seeing colored halos, rainbows around lights
tearing
headache
N/V

OTHER SYMPTOMS
vision loss in periphery
blind spots
blurred vision
fluctuation of vision
vague eye itching
inability to adjust eye to darkened rooms
difficulty focusing on close work

Front 8

What are major risk factors for glaucoma?

Back 8

age > 45
Fam Hx
African American
DM
Hx of elevated IOP
Eye injury
Use of cortisone - monitor eye if used more than 2 wks
Near and Far sightedness

Front 9

What is the Class of Choice? MOA?

What other classes can be used? MOA?

Back 9

class of choice: prostiglandin analogues
MOA - increases outflow of aqueous humor

others:
BBlockers
MOA: surpress production of aqueous humor

sympathomimmetics
MOA: increase outflow of aqueous humor

Miotics - cholinergics (parasympathomimmetics)
MOA: increases outflow of aqueous humor

carbonic anydrase inhibitors
MOA: suppress outflow of AH

Front 10

List the prostaglandin analogs. (4)

Dose?

Back 10

Xalantan (lantaprost) - 1 gtt in affected eye q hs
***REFRIGERATE UNTIL DISPENSED***

Lumigan (bimatoprost) - 1 gtt in affected eye q hs

Travatan (travaprost) - 1 gtt in affected eye q hs

Rescula (unprostone) - 1 gtt BID**!*

Front 11

Miotics - Cholinergics (parasympathomimetics) (3)

Back 11

Ocusert Pilo-20 (pilocarpine insert)
releases 20 mcg/hr x 1wk so must be replaced q wk

NOT USED MUCH ANYMORE
pilocarpine
carbachol

Front 12

Sympathomimetics (4)

Back 12

Alphagan P (brimonidine tartrate) - 1 gtt in affected eye q 8 hr (TID)

Iopidine (apraclonidine) - used post op w other drugs when IOP not well controlled

Propine (dipivefrin)

Epifrin, Glaucon (epinephrine)

Front 13

BBlockers (6)

Are BBlocker eye drops systemically absorbed?

What is the only one that is B1 selective?

Back 13

Timoptic (timolol)

Timoptic-XE (timolol gel)

Ocupress (carteolol)

Betagan (Levobunolol)

OptiPranolol (metipranolol)

Betoptic S (Betaxolol)

Front 14

Carbonic Anhydrase Inhibitors (5)

What two are not systemically absorbed?

Back 14

Trusopt (Dorzolamide)
Azopt (brinzolamide)

systemically absorbed
Diamox (acetazolamide)
Neptazane (methazolamide)
Daranide (dichlorphenamide) -assoicated with tachyphylaxis, rapid tolerance)

Front 15

What are combination products and what classes? (2)

Back 15

bblockers/carbonic anhydrase inhibitors

Cosopt (timolol/dorzolamide)

Combigan (timolol/brimonidine) - protect from light