Glaucoma and Its Treatment

Study Notes

Primary open-angle glaucoma is the most common type, characterized by optic nerve damage and no symptoms, but is painless.
Treatment is directed at reducing elevated intraocular pressure (IOP) to slow or stop disease progression.
First-line treatment options:
- Beta blockers (BB) decrease aqueous humor production, with Betaxolol being the only selective ophthalmic BB.
- Alpha-2 (A2) agonists, such as Brimonidine, which decrease production and are approved for long-term therapy, but can cross the blood-brain barrier (BBB) causing drowsiness and hypotension.
- Apraclonidine, an A2 agonist, is used for short-term therapy and does not cross the BBB, avoiding hypotension.
- Prostaglandin analogs, such as Latanoprost, facilitate aqueous humor outflow and can increase pigmentation.
Second-line treatment options:
- Cholinergic drugs, such as Pilocarpine, constrict the ciliary muscle, facilitating outflow and indirectly lowering IOP, but can cause retinal detachment and decreased visual acuity.
- Carbonic anhydrase inhibitors, such as Dorzolamide and Brinzolamide.
- Echothiopate, which slows production, is only used for those who do not respond to preferred treatment.

Characterized by displacement of the iris, preventing aqueous humor exit, and increasing IOP.
Extremely painful, with vision loss possible within 1-2 days if left untreated.
Treatment involves drug therapy followed by corrective surgery.