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Glaucoma
- disease characterized by higher than normal intraocular pressures.
- Normal intraocular pressure is 21 mmHg.
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Closed Angle Glaucoma
- Caused by a mechanical block of the outflow of aqueous humor through the Canal of Schlemm
- Can occur with dilation of the eye in patients with small anterior chambers
- Accounts for only about 5% of all glaucomas
- Intraocular pressure may increase by 50 mmHg
- A medical emergency
- Monocular - usually occurs in just one eye
- Laser surgery may be useful in correcting this problem
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Open Angle Glaucoma
- Caused by decrease outflow or increased production of aqueous humor
- Account for about 90% of all glaucomas
- A chronic, slowly progressive disease
- Usually occurs after age 50
- Bilateral � usually occurs in both eyes
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Beta Blockers for treatment of Glaucoma
- Decrease production of aqueous humor
- Do not cause blurred vision
- Use with caution in patients with asthma, diabetes and CHF
- Topical
- Timolol (Timoptic�)
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Alpha-2 Agonists for treatment of Glaucoma
- Decreased production of aqueous humor
- Increased uveoscleral outflow
- Use with caution in patients with severe cardiovascular disease
- Topical agent: Brimonidine (Alphagan)
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Parasympathomimetic Agents (Cholinergics)
- Cause contraction of ciliary muscles which opens trabecular meshwork, leading to increased outflow of aqueous humor
- Often cause decreased vision and headache
- Topical agent:
- Pilocarpine (Isopto Carpine�, Ocusert Pilo, Pilopine HS, Pilagan)
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Sympathomimetic Agents
- Stimulation of alpha receptors increases outflow of aqueous humor
- Usually combined with other agents
- Often cause blurred vision
- Topical agent: Apraclonidine (Iopidine), Epinephrine (Epifrin�)
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Carbonic Anhydrase Inhibitors
- Cause decreased production of aqueous humor
- Associated with numerous side effects (drowsiness, malaise & depression
- Used after other drugs have failed
- Topical, Oral or Intravenous
- Acetazolamide (Diamox)
- Brinzolamide (Azopt)
- Dorzolamide (Trusopt)
Prostaglandin Agonist
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Cause increased outflow of aqueous humor
- May gradually change eye color
- Can cause blurred vision or stinging and burning of the eye
- Used after other drugs have failed
- Administer 5 minutes apart from other drugs
- Topical
- Latanoprost (Xalatan)
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