Term
| What are risk factors for open angle glaucoma? |
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Definition
- AGE
- family history
- Hyper and hypotension
- Trauma and reduced blood flow
- Vasospasms - migraines, reynaud's |
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Term
| What medications can worsen open angle glaucoma? |
|
Definition
- Ophth corticosteroids!!
- Systemic/inhaled steroids
- Ocular atropine - for mydriasis |
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Term
| What are signs and symptoms of glaucoma? |
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Definition
- Disk cupping
- Splinter hemorrhages
- Peripheral visual field loss |
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Term
| What is the primary action plan for open angle glaucoma? |
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Definition
- Initial tx with a prostaglandin analogue OR beta blocker, monitor IOP, then
- increase strength if not at goal, or add another class, OR
- If it does not decrease, try a different class
**First line: Prostanglandin analogues or Beta Blockers |
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Term
| What are 2nd line medications for glaucoma? |
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Definition
- Alpha agonists
- Carbonic anhydrase inhibitors
**3rd line: miotic or systemic CAs |
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Term
| What are prostaglandin analogues and how are they used? |
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Definition
Improve uveoscleral outflow, all dosed 1 gtt QHS
- Latanoprost - Xalatan® - i drop hs
- Bimatoprost - Lumigan® - i drop hs
- Travoprost - Travatan® - i drop hs
- Tafluprost – Zioptan® - i drop hs - No preservatives
AE:pigmentation, inflammation, eyelash growth |
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Term
| What are topical beta blockers and how are they used? |
|
Definition
Reduce AH production - cheap, diff strs
- Timolol - 1 gtt qd or BID
- Levobunolol/Betagan - 1 qd to BID
- Carteolol/Ocupress - 1 BID
- Betaxolol/Betoptic - 1 BID
AEs very rare, can include system |
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Term
| What are Alpha-agonists and how are they used? |
|
Definition
Reduce AH production
- Brimonidine/Alphagan P - 1 BID or TID
- Apraclonidine/Iopidine - not for long term use, post-surgery
AE: foreign body sensation in the eye! |
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Term
| What are carbonic anhydrase inhibitors and how are they used? |
|
Definition
Decrease AH production
- Dorzolamide/Trusopt - 1 BID to TID
- Brinzolamide/Azopt - 1 BID to TID
Systemic:
- Acetazolamide, Methazolamide - used in closed angle only due to AEs - cramps, lethargy, acidosis, hypokalemia |
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Term
| What are miotics and how are they used? |
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Definition
Improve AH outflow - limited use due to AEs: miosis, blurry vision, cataracts
- Pilocarpine
- Carbachol |
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Term
| What are contraindications to glaucoma medications? |
|
Definition
- Active Respiratory distress – beta blockers
- Advanced heart disease – beta blockers
- Cardiac arrythmia – Adrenergic agonists
- Hx of kidney stones – systemic CAIs
- Retinal detachment – Miotic drugs |
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