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5 Cards in this Set
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A 70 year old woman comes to the emergency department with the sudden onset of a painful, red eye. The cornea is hazy and edematous. The pupil is fixed at the midpoint and is nonreactive. Visual acuity is decreased.
What are the best initial medical treatments? |
Acute closed-angle glaucoma is treated with medications to increase the drainage of aqueous humor and to decrease the production of aqueous humor. Timolol and pilocarpine drops are the best initial therapy. They constrict the pupil.
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A 70 year old woman comes to the emergency department with the sudden onset of a painful, red eye. The cornea is hazy and edematous. The pupil is fixed at the midpoint and is nonreactive. Visual acuity is decreased.
How do these treatments work? |
1) Beta blockers (timolol, betaxolol) constrict the pupil and increase both drainage of fluid as well as inflow.
2) Cholinergic agonist (pilocarpine) increase drainage of the aqueous humor by opening the canal of Schlemm. 3) Carbonic anhydrase inhibitors (acetazolamide, dorzolamide) decrease the production of aqueous humor. 4) Alpha adrenergic agonist (apraclonidine, brimonidine) increase drainage. 5) Prostaglandin analogs (latanoprost or travoprost) increase drainage. |
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A 70 year old woman comes to the emergency department with the sudden onset of a painful, red eye. The cornea is hazy and edematous. The pupil is fixed at the midpoint and is nonreactive. Visual acuity is decreased.
What is the treatment if medical therapy fails? |
If medical therapy does not control ocular pressure, a laser trabeculoplasty or iridotomy is performed. This puts a physical hole in the iris, allowing for drainage of fluid.
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Two patients present with progressive loss of vision. Both are older and generally healthy, without diabetes or hypertension. One has atrophic or "dry" macular degeneration with multiple drusen visible. The other has "wet" or proliferative disease.
What is the therapy for the first patient? |
Dry, or atrophic macular degeneration has no proven effective therapy. Laser therapy does NOT help, and the disease will progress slowly over time.
Antioxidant vitamins, such as vitamins A, C, and E, as well as zinc may offer some benefit and should be used. |
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Two patients present with progressive loss of vision. Both are older and generally healthy, without diabetes or hypertension. One has atrophic or "dry" macular degeneration with multiple drusen visible. The other has "wet" or proliferative disease.
What is the therapy for the second patient? |
Wet or proliferative (exudative) macular degeneration has more therapeutic options. Treatment is with vascular endothelial growth factor (VEGF) inhibitors, such as ranibizumab, bevacizumab, or pegaptanib. These drugs are unique in teh they can actually restore vision, not just delay worsening. Laser photocoagulation can be useful; verteporfin is photosensitizing dye that is injected and activated by subsequent retinal laser irradiation to produce selective vascular damage
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