EYE DISORDERS.docx

[EYE DISORDERS ] GLAUCOMA Primary open-angle glaucoma is most common; optic nerve damage; no symp; painless. Tx is directed at reducing elevated IOP slow or even stop disease progression Drugs lower IOP by either 1) facilitating aqueous humor outflow or 2) reducing aqueous humor production. Firs...

[EYE DISORDERS ] GLAUCOMA Primary open-angle glaucoma is most common; optic nerve damage; no symp; painless. Tx is directed at reducing elevated IOP slow or even stop disease progression Drugs lower IOP by either 1) facilitating aqueous humor outflow or 2) reducing aqueous humor production. First line: 1. BB- first choice! Decreases production. a. **Betaxolol** is the only selective ophthalmic BB 2. A2 agonist b. **Brimonidine**- decreases production i. Approved for long-term therapy ii. Crosses BBB drowsy, hypotension c. **Apraclonidine** iii. Short term therapy iv. Does not cross BBB no hypotension 3. Prostaglandin analogs "prost" d. **Latanoprost**- facilitates aqueous humor outflow v. Inc pigmentation, Second line: 1. Cholinergic drug a. **Pilocarpine** miosis (constricts) and contraction of ciliary muscle indirectly lowers IOP by facilitating outflow i. AE: retinal detachment, decrease visual acuity 2. Carbonic anhydrase inhibitor b. **Dorzolamide and brinzolamide** c. **Echothiopate**- slows production ii. Only for those that do not respond to preferred tx Angle-closure glaucoma- displacement of iris prevents exit of aqueous humor inc IOP. Extremely painful. Vision loss can occur 1-2 days if not treated. Tx involves drug therapy follow by corrective surgery! ALLERGIC CONJUNCTIVITIS 1. Mast cell stabilizers 2. Antihistamines 3. NSAID (ketorolac) 4. Glucocorticoids prolonged therapy can cause cataracts, reduced visual acuity and glaucoma. Also increased risk of infection. DO NOT GIVE w/ PRESENCE OF INFECTION permanent vision loss 5. Ocular decongestants