Treatment of
Glaucoma
- Vigneswar PA
Anatomy of Eye
The eyeball is made of 3 layers,
outer layer -> cornea, sclera, limbus
middle layer -> iris, ciliary body, choroid
inner layer -> also known as retina
Ciliary body of the middle layer of eye produces
the aqueous humour into the posterior chamber
of eye
Layers of eyeball
Continuation…
Spaces of eyeball,
Posterior segment -> contains the vitreous humour
Anterior segment -> again divided into anterior
and posterior chamber
-> contains the aqueous humour
-> 90% of aqueous humour is
drained
(remaining 10% via Into trabecular outflow in the
uveoscleral outflow) angle of anterior chamber
Spaces of eyeball
Flow of Aqueous
Humour
Glaucoma
Glaucoma is a group of eye diseases that can
cause vision loss and blindness by damaging a
nerve in the back of your eye called the optic
nerve.
(which can be due to raised IOP)
Changes seen in glaucoma
1. Optic disc changes
2. Visual field changes
3. Intraocular pressure (may or may not be raised)
Classification of
Glaucoma
Glaucoma is broadly classified into
1. Open angle glaucoma
- due to defect in drainage of aqueous
2. Angle closure glaucoma
- due to blockage of trabecular
meshwork by
iris (angle of the eyeball gets closed)
Continuation…
Open angle Glaucoma
Most common in old age people (>50 years)
Symptoms -> headache, delayed dark adaptation,
frequent changes in presbyopic glasses
Signs -> Laminar dot sign: Fenestrations of sclera
are
abnormally visible as grey white
dots
-> Splinter haemorrhages on optic disc surface
-> Bayonetting sign: double angulation of
blood
Treatment of
Open Angle Glaucoma
Most of the sign and symptoms in glaucoma are due
to excess accumulation of aqueous humour in
anterior segment
Glaucoma can be medically treated by,
1. Decreasing the aqueous humour secretion (inflow)
2. Increasing the aqueous humour drainage either by
trabecular outflow or uveoscleral outflow
Drugs for
Open Angle Glaucoma
1) Decreasing aqueous humour inflow
Beta adrenergic blockers
Alpha Adrenergic agonists
Carbonic anhydrase inhibitors
2) Increasing aqueous humour outflow
Prostaglandin analogues (via uveoscleral outflow) (Drug of
choice)
Miotics (by increasing ciliary muscle tone thereby improving
trabecular outflow)
Medical Treatment of
Open Angle Glaucoma
Beta Adrenergic Blockers
Examples :Timolol, Betaxolol, Levobunolol
Mechanism of Action: Decreasing the production of
aqueous
Ocular side effects : Blepharoconjunctivits
: Nasolacrimal duct blockage
: Corneal anaesthesia
: Aphakic cystoid macular edema
(seen
only with Betaxolol)
Continuation…
Contraindications: Arrhythmia
: Bronchospasm
: Congestive heart failure
: Diabetes mellitus
Alpha Adrenergic Agonists
Examples: Apraclonidine, Brimonidine
Mechanism of action:
Brimonidine-> By decreasing aqueous inflow
Apraclonidine-> By decreasing aqueous inflow &
increasing trabecular outflow
Side effects:
Apraclonidine -> Follicular Conjunctivitis
-> Mydriasis
-> Eyelid retraction
Continuation…
Side effects:
Brimonidine: Drowsiness
: Depression
: Apnea
: Bradycardia
Contraindications:
Brimonidine is a CNS depressant and is contraindicated
in children
Thank
You
