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25 Cards in this Set
- Front
- Back
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Definition of Glaucoma
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• A spectrum of ophthalmic disorders
characterized by neuropathy of the optic nerve and loss of retinal ganglion cells which leads to permanent deterioration of the visual field and potentially total vision loss. |
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Subjective data for open-angle(3)
-symptoms presented -effect on vision |
-often asymptomatic
-loss of peripheral vision -Blind spots in field of vision |
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Subjective data for angle-closure
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• Ocular pain
•Red eye • Blurred vision • Halos around lights • Other: nausea, vomiting, abdominal pain, headache, diaphoresis *Vision loss can occur as soon as hours to days |
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Glaucoma objective data
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• Routine eye exam
• Optic nerve head cupping • Large cup-disc ratio • Diffuse thinning • IOP > 21 mmHg (not required) • Pachymetry: corneal thickness (< 540 microns) •Perimetry • Gonioscopy |
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Which glaucoma has higher pressure?
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Angle closure(40-50mmHg)
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ACG non-pharmacologic tx
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Surgical iridotomy
laser iridotomy(as opposed to trabecular) |
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First line OAG tx
how to monitor Alt. first line? |
Beta blocker(assess response 2-4 weeks)
alt: Prostaglandin or brimonidine |
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Patient-related variables for BB(Betaxolol)?
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COPD, bradycardia, CHF
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agent-related variables for BB?(Betaxolol, Timolol)
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– First line
– Betaxolol (selective antagonist - ?safer pulm) – Tachphylaxis 20-50% – ?long-term tolerance – BAK preservative |
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BB indices of toxicity(Betaxolol, Timolol)
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– ADEs:
• Local: stinging, conjunctivitis, keratitis, dry eyes, uveitis • Systemic: pulmonary, cardiovascular – Timolol: tachyphylaxis (20-50%) |
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Agent-related variables with Prostaglandin analogs
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– First line option
– Alternative to beta-blocker (intolerant or contraindicated patients) – Becoming gold standard: excellent safety – Preservative-free –QHS |
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Prostaglandin analog indices of toxicity
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– Local: conjunctival hyperemia, stinging, iris
pigmentation, hypertrichosis, darkening of eyelashes – Systemic: rare |
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Agent-related variables of alpha-2-agonist(Apraclonidine, brimonidine)
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– ? Neuroprotective (Low-Pressure Glaucoma
Treatment Study) – Prevention and treatment post-surgical IOP elevations – Not used long-term: brimonidine better LT than apraclonidine |
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Indices of toxicity in Alpha-2-agonist(Apraclonidine, brimonidine)
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– Local: blepharoconjunctivitis, foreign body
sensation, pupillary mydriasis, eyelid retraction – Systemic: headache, dry mouth, fatigue |
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Pt related variables for cholinergic agonist
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– Dark irides
– Severe myopia |
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Agent-related variables for cholinergic agonist(carbachol, pilocarpine)
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– First line option
– Pilocarpine gel Qday admin – QID admin – ?long-term: cataracts |
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Indices of toxicity for cholinergic agonist(carbachol, pilocarpine)
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– Local: accomodation spasm, myopia, brow
ache, decreased night vision – Systemic: nausea, vomiting diarrhea, bradycardia |
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When other drugs fail use these...
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Che inhibitors(echothiphate)
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Avoid these if allergic to sufa
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Carbonic anhydrase inhibitor(brinzolamide, acetazolamide)
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Agent-related variables of carbonic anhydrase inhibitors(Brinzolamide, acetazolamde, dichlophenamide)
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– Adjunctive or monotherapy alternative
– Systemic: use in acute ACG otherwise 3rd line d/t ADEs |
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Carbonic anhydrase inhibitor indices of toxicity(Brinzolamide, Dorzolamide, acetazolamide, dichlophenamide, methazolamide)
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– Local: burning, stinging, itching, foreign body
sensation, dry eyes, conjunctivitis, irreversible corneal decompensation, taste abnormalities – Systemic: paresthesias, nausea, vomiting, weight loss, acidosis, hypo K+, hypo Na+, nephrolithiasis |
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Benefits of Combo tx(potential)
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• Improved efficacy
• Reduce exposure to preservatives • Simplified regimens •Cost ? • Increased adherence |
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RFs for OAG
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Elevated IOP
African or hispanic FH Older Thinner Central corneal thickless |
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RFs for ACG
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Advancing age
Asian or Eskimo Female Hyperopia Shallow anterior chamber FH |
