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CH 104: Eye

Glaucoma refers to a group of diseases characterized by visual field loss secondary to optic nerve damage
Primary open-angle Glaucome - most common form of glaucoma & leading cause of blindness - characterized by progressive optic nerve damage w/ eventual impairment of vision - Painless & symptoms do not arise till optic nerve damage has been produced
Risk factors for OAG - Elevated IOP - African or south american - family history of POAG - advanging age ** elevated IOP most important**
Most important form of prevention of blindness from OAG? - screening!
Managements of OAG - directed at reducing elevated IOP
Angle-Closure Glaucome - displacement of iris such that it covers trabecular mesh-work, preventing exit of aqueous humor from the anterior chamber \ - IOP raises rapidly to dangerous levels- VERY PAINFUL - no tx leads to irreversible vision loss in 1-2 days
TX OF ACG - drug therapy followed by corrective surgery - once IOP is decreased, laser iridotomy and iridectomy may be performed
BETA BLOCKERS - first line drugs for glaucoma - lowers IOP by decreasing production of aqueous humor - used primarily for OPEN-ANGLE GLAUCOMA
Beta Blockers Adverse Effects - Local effects (burning, conjuctivitis, blurred vision, photophobia) - Heart and lung effects : produce bradycardia & AV block (monitor pulse rate)
Beta blocker contradictions - not to be used in patients with AV Block, sinus bradycardia, cardiogenic shock ** CAUTION IN PATIENTS W/ HEART FAILURE** - causes bronchostriction - betaxolol only apprived BB for patients w/ asthma & COPD
Prostaglandin analogs: LANTAPROST - applied topically to lower IOP in patients w/ OPEN ANGLE GLAUCOMA & OCULAR HYPERTENSION
Lantaprost MOA - lowers IOP by facilitating aqueous humor outflow in part by relaxing the ciliary muscle
Lantaprost SE: - harmless BROWN pigmentation of the iris - may also increase length, thickness, and pigment of eyelashes - blurred vision, buring/stinging, conjuctival hyperemia, punctate keratopathy.
Other Prostaglanding analogs - travopost, bimatoprost, taflupost reduced IOP by increasing aqueous humor outflow - more effecting in African Americans - Bimatoprost (Latisse) helps grow longer & thicker eyelashes - common SE: ocular hyperemia (engorgement of ocular blood vessels)
Alpha2-adrenergic agonists: Brimonidine - LONG term reduction of elevated IOP in pt's w/ OPEN ANGULAR/ ocular hypertension MECH OF ACTION: lowers IOP by reducing aqueous humor production, and increasing outflow - may delay optic nerve damage
Brimonidine side effects: - dry mouth, ocular hyperemia, burning/stinging, foreign body sensation. ocular itching - CAN CROSS B-B-B and cause drowsiness, fatigue, hypertension ** absorb into contact lenses, advise pt to administer 15 minutes before placing lenses
Alpha2-adrenergic agonists: Apraclonidine - SHORT TERM THERAPY - lowers IOP by reducing aqueous humor production and increasing outflow (same as Brimonidine) - For OAG pt's who did not respond well to other drugs
Alpha2-adrenergic agonists: Apraclonidine side effects: - headache, dry mouth and nose, altered taste, etc DOES NOT CROSS B-B-B = NO HYPOTENSION
Pilocarpine: direct acting muscarinic agonist - stimulates cholinergic receptors producing (1) miosis (2) contraction of the ciliary muscle- IOP lowered indirectly - Patients with OAG IOP is reduced due to tension generated by contracting ciliary muscle promotes widening within the trabecular mesh
Pilocarpine: direct acting muscarinic agonist effect on ACG - contraction of iris sphincter pulls iris away from the pores of the trabecular mesh, removing impediment to aqueous humor flow
Pilocarpine: direct acting muscarinic agonist THERAPEUTIC USES: - 2nd line drug for OAG & used in emergencies for Acute-angle-closure glaucoma
Pilocarpine: direct acting muscarinic agonist ADVERSE EFFECTS: - may need corrective lens for near vision, retinal detachment, decrease visual acuity. Systemic: bradycardia, bronchospasm, hypersalivation, diarrhea, **CAUTION USE W/ ASTHMA & bradycardia** - toxicity reversal: atropine (muscarinic antagonist)
Echothiophate: cholinesterase inhibitor - long duration of action - inhibits breakdown of Acetylcholine, promoting accumulation of ACHE at muscarinic receptors - Indicated for POAG
Echothiophate: cholinesterase inhibitor adverse effects: - myopia and excessive constriction ***CATARACTS***
Carbonoc Anhydrase inhibitors: topical Dorzolamide - reduces IOP in patietns w/ OAG - lower IOP by decreasing production of aqueous humor
Carbonoc Anhydrase inhibitors: topical Dorzolamide SIDE EFFECTS: - BITTER TASTE & ocular stinging
Carbonoc Anhydrase inhibitors: systemic ACETAZOLAMIDE & METHOZOLAMIDE - lower IOP by decreasing production of aq. humor. - for long term tx of OAG ADVERSE EFFECTS: CNS ( malaise, anorexia, fatigue) , MALAISE may be intense, GI disturbances - HARMFUL TO PETS AND PREGNANCY
Cycloplegics - paralyze ciliary muscles
mydriatics - dilate the pupil
cycloplegics and mydriatics - use to facilitate dx and surgery
Created by: KristinL