32 Glaucoma

Aqueous Humor

• aqueous humor in anterior chamber of eye before iris

• posterior chamber behind iris, in front of lens

• gives eye shape and nourishes the eye

• ciliary secrete into posterior chamber, migrate to anterior, then to canal of schlemm

Intraocular Pressure

• creates pressure in anterior chamber of eye

Glaucoma

• angle formed by iris, ciliary muscle

• left: open angle glaucoma

• right: closed angle glaucoma

Closed Angle

• rarer

• muscle dilating causes iris muscle to contract, can close the angle more, cause more pain

• eye surgery definitive

• multiple drugs used while waiting surgery

Open Angle

• far more common

• elderly

• steroid usage: remodel of trabecular meshwork, less drainage

• most patients primary

• uveitis: impaired drainage

• disc cup: bright area 1/3 size of optic disc

• glaucoma: optic cup very big

Glaucoma Drugs

Parasympathetics

• closes iris, improves angle

• contracts ciliary muscle

Alpha

B blockers

PGE

• "F": PGF2a

• LA tan sandals: latanoprost (PGF2a)

• World traveler boots: travoprost (PGF2a)

• Leaking eyeballs: latanoprost and travoprost treat glaucoma by increasing aqueous humor outflow (not production)

• Brown sunglasses: latanoprost and travoprost can produce brown pigmentation in iris

Diuretics

Sympathetic

• not used anymore