Term
| Pathophys of Glaucoma is IOP build up where? |
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Definition
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Term
| Fluid build up removed in 2 ways |
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Definition
1. Filtration through trabecular meshwork to Schlemm's canal
2. Through Ciliary body & suprachoroidal space |
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Term
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Definition
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Term
| Non-modifiable factors of IOP |
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Definition
Posture
Neck Compression
Gender |
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Term
| Modifiable Factors of IOP |
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Definition
Bp Pulse
Coughing Smoking
Caffeine |
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Term
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Definition
Tonometry Gonioscopy
Pupil Dilation Optic Nerve image
Visual Field Testing |
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Term
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Definition
bilateral
Normal IOP
Decrease outflow of eye fluid |
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Term
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Definition
PDS (Pigmentary Dispersion Syndrome)
-pigmetn released from iris & deposited on anterior & posterior chambers of eye
PES (Pseudoexfoliation Syndrome)
-Flaky,dandruff-like exfoliative stuff on anterior and posterior |
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Term
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Definition
AA
Age >60 yrs Fam Hx
IOP>21mmHg
Thin Cornea Myopia |
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Term
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Definition
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Term
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Definition
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Term
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Definition
optic nerve dmg +/- visual field DAMAGE
-Tx Lower IOP by >25%
-Meds, Laser Trabeculoplasty |
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Term
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Definition
optic nerve dmg + visual field LOSS
-Tx Lower IOP by 25-50%
-Meds, Laser trabec +/- Mitomycin C or Tube(+/- cataract removal & intraocular lens), &/or Cyclophotocoaglation (or cryotherapy) |
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Term
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Definition
Blind eye+/- Pain
-Tx Lower IOP by 25-50%
-Meds, Cyclophotcoagulation, rehab |
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Term
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Definition
| No changes in IOP, optic nerve, visual field. |
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Term
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Definition
Tx: Continue current Tx
FU: 4-12 months |
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Term
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Definition
| Worsening IOP, optic nerve, visual field. |
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Term
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Definition
Tx: Additional Lowering of IOP by at least 25%
FU: 1-4 months depending on severity |
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Term
| When Laser Trabeculoplaty used? |
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Definition
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Term
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Definition
3rd line for mod/advanced cases
-requires med tx even after Tx |
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Term
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Definition
-Prostaglandin Analogs
-Alpha 2 adrenergic agonists
-Beta blockers
-Carbonic anhydrase inhibitors
-Cholinergic Agonists (Miotics) |
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Term
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Definition
BB
&
Prostaglandins Analogs
(or Brimonidine) |
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Term
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Definition
| Betaxolol -selective for Beta1 (least reduction in IOP of BBs) |
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Term
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Definition
Levobunolol
Metipranolol
Timolol
Carteolol |
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Term
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Definition
-Dec production of aqueous humor by ciliary body
-BID (except timoptic xe)
-Lower IOP 20-30% |
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Term
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Definition
-Gel forming
-Only once daily B! |
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Term
| Least likely BB to produce SYS FX |
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Definition
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Term
| Prostaglandin Analogs MOA |
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Definition
| -Inc outflow of aqeuous humor -Dec IOP 25-35% -Once daily (Bedtime) |
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Term
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Definition
Prostaglandins
-Latanoprost,Travoprost,Tafluprost
Prostamide
-Bimatoprost |
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Term
| When is Latanoprost more effective |
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Definition
-QHS
(equivalent IOP lowering as Timolol) |
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Term
| More effective in Afr Amer pop |
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Definition
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Term
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Definition
Darkened Iris
Inc eyelash growth
Eyelid Hyeprpigmenting(reversible)
Herpetic Keratitis |
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Term
| Preservative free Prostaglandin analog |
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Definition
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Term
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Definition
Brimonidine (1st line)
Apraclonidine
-Both BID to TID dosing |
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Term
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Definition
Dec rate of aqueous humor production
-Dec IOP 18-27% at peak (2-5 hrs) & 10% at 8-12 hrs |
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Term
| Alpha Agonist useful when |
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Definition
-Post opp
-or post laser tx |
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Term
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Definition
| Apraclonidine (high side efx causes limited longterm use) |
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Term
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Definition
-Can be used single agent 1st line
-Similar efficacy as timolol
-23-32 times more selective than apraclonidine |
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Term
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Definition
-Allergic type ADRs:Lid edema, itch
-Dizzy,dec hr/BP |
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Term
| Alpha Agonists Caution with what drugs |
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Definition
MAOIs, TCAs
-Concurrent Antihtn |
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Term
| Carbonic Anhydrase Inhibs |
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Definition
Topical: Brinzolamide, Dorzolamide -(IOP dec 15-26%) Systemic: Acetazolamide, Methazolamide -(IOP dec 25-40%)
[Can use 1st line if Contra to other 1st lines] |
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Term
| Carbonic Anhydrase Inhibs MOA |
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Definition
| -Inhibit aqueous production by blocking active secretion of Na+ and bicarb ions from ciliary body |
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Term
| Carbonic Anhydrase Inhibs place in Tx |
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Definition
| Alt for MonoTx or adjunt Tx for pt w/ inadequate response or unable to use other agents |
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Term
| Carbonic Anhydrase Inhibs ADRs |
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Definition
| Topical: Burn, sting, blur vision,tears Systemic: Altered taste |
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Term
| Carbonic Anhydrase Inhibs caution use in pt with |
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Definition
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Term
| Do not use Carbonic Anhydrase Inhibs with |
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Definition
| Topical Carbonic Anhydrase Inhibs with systemic is a NO NO! |
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Term
| Caution SYS Carbonic Anhydrase Inhibs in |
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Definition
| Hep dis, ren dis, kidney stones, DM, addisons dis, resp acidosis |
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Term
| SYSTEMIC Carbonic Anhydrase Inhibs indicated for |
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Definition
| pt failing to respond to max tolerated dose of topical Tx. |
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Term
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Definition
Dipivefrin
-1 drop BID dose |
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Term
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Definition
Unknown
B2 receptormediated inc in outflow thru trabecular meshwrk and uveoscleral route? |
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Term
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Definition
Direct acting: Pilocarpine,Carbachol (Cholinergic agonists)
Indirect Acting: Echothiophate(cholinesterase inhibs) |
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Term
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Definition
| -Cataracts, retinal detchment,asthma,ulcers, PARKINSONS, bladder dysfunc |
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Term
| Combo Products used when? |
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Definition
| Max dose single agents only do partial response |
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Term
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Definition
COMBIGAN: Brimonidine, Timolol
COSOPT: Dorzolamide, Timolol
SIMBRINZA: Brimonidine, Brinzolamide |
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Term
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Definition
-Dec IOP 25%
-Bind CB1 and CB2 |
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Term
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Definition
10% of Glaucoma
-often no SXs
-Chronic or acute |
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Term
| Closed Angle Glaucoma ACUTE |
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Definition
IOP inc (40-90mmHg)
Blur vision
HA, Eye red,Ab pain Diaporesis |
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Term
| Closed Angle Glaucoma CHRONIC |
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Definition
Normal or elevated IOP
HA
Blur vision w/ Halos around Light |
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Term
| Closed Angle Glaucoma Risk Factors |
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Definition
>60 yrs
Farsightedness(Hyperopia)
Asian
Fam Hx
Female |
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Term
| Closed Angle Glaucoma ACUTE Tx |
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Definition
Oral Glycerin
IV Mannitol
_Surgery after acute attack
(cureable)
-Long term Tx not usual |
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Term
| Closed Angle Glaucoma CHRONIC Tx |
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Definition
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Term
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Definition
| Wash hands, Shake susp 10 secs, lower eyelid, thumb/index finger, close eyes 2-3 mins, 5 mins between multiple drops, 10 mins between dif drug drops |
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Term
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Definition
| open angle glaucoma (80-90% of cases) |
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