Glaucoma chronic open-angle

Identify risk factors for the development of chronic open-angle glaucoma and acute angle-closure glaucoma. 

Glaucoma Initial therapy or as an adjunct with other antiglaucoma agents for the control of intraocular pressure (lOP) in chronic open-angle glaucoma. 

Carteolol (Cartrol/ Ocupress Ophthalmic) [Beta Blocker/ Glaucoma Agent] Uses HTN, T lOP, chronic open-angle glaucoma Action Blocks [3-adrenergic receptors (p, 2)1 ISA Dose Ophth 1 gt in eye(s) bid Caution [C (1st tri) D (2nd 3rd tri), /-] Cardiac failure, asthma Contra Sinus bradycardia heart block >lst-degree bronchospasm Disp Ophth soln SE Drowsiness, sexual dysfxn, bradycardia, edema, CHF, ocular conjunctival... 

Blockers can be used topically to reduce intraocular pressure in patients with chronic open-angle glaucoma and ocular hypertension. The mechanism by which ocular pressure is reduced appears to depend on decreased production of aqueous humor. Timolol has a somewhat greater ocular hypotensive effect than do the available cholinomimetic or adrenomimetic drugs. The 3-blockers also are beneficial in the treatment of acute angle-closure glaucoma. 

Chronic open-angle glaucoma and ocular hypertension Ophthalmic (solution) 1 drop... 

Timolol [TIM o lole] and nadolol [NAH doh lole] also block Pi and P2 adrenoceptors and are more potent than propranolol. Nadolol has a very long duration of action (see Figure 7.5). Timolol reduces the production of aqueous humor in the eye and is used topically in the treatment of chronic open-angle glaucoma, and occasionally for systemic treatment of hypertension. 

Ritch R, Shields MB, Krupin T. Chronic open-angle glaucoma treatment overview. In Ritch R, Shields MB, Krupin T, eds. The Glaucomas, ed. 2. St. Louis, MO Mosby 1996 1512. 

Adrenaline (topical) decreases intraocular pressure in chronic open-angle glaucoma, as does dipivefrine, an adrenaline ester prodrug. They are contraindicated in closed-angle glaucoma because they are mydriatics. Hyperthyroid patients are intolerant of adrenaline. 

Trade names Betaxon (Alcon) L-betaxolol Indications Chronic open-angle glaucoma, ocular hypertension Category Adrenergic beta-receptor antagonist Half-life 20 hours... 

Dipivefrin is a prodrug of epinephrine and is converted to epinephrine in the eye by hydrolysis. It exerts its action by decreasing aqueous production and enhancing outflow facility. It is indicated in controlling intraocular pressure in chronic open-angle glaucoma. 

Echothiophate is a cholinesterase inhibitor that causes miosis, increase in facility of outflow of aqueous humor, a fall in lOP, and potentiation of accommodation by enhancing the effect of endogenously liberated acetylchohne in the iris, ciliary muscle, and other parasympathetic innervated structures of the eye. It is indicated in the treatment of chronic open-angle glaucoma and treatment of accommodative esotropia (see also Figure 12). 

Metipranolol, a beta-adrenergic-blocking agent (instill 1 drop in each affected eye b.i.d.), is used in the treatment of ocular conditions in which lowering of lOP would be beneficial (ocular hypertension, chronic open-angle glaucoma). 

Timolol (10 mg t.i.d.) alone or in combination with other antihypertensive agents, such as thiazide diuretics, is used in the management of hypertension. Timolol is indicated for the treatment of myocardial infarction and prophylaxis of migraine headaches. Timolol (1 drop of 0.25% solution twice daily) is effective in lowering intraocular pressure in patients with chronic open-angle glaucoma. 

Tarkkanen, A., and Kurjalainen, K. (1966). Cataract formation during miotic treatment for chronic open-angle glaucoma. Acta Ophthalmol. 44, 932-939. 

Relative transdermal scopolamine may cause mydriasis leading to an increase in intraocular pressure in patients with chronic open-angle (wide-angle) glaucoma and should be used with caution. Patients with known liver or kidney dysfunction should use scopolamine patch with caution. Patients with history of psychosis or seizures should also avoid transdermal scopolamine. 

Since primary open-angle glaucoma is a chronic, often asymptomatic condition, the decision of when and how to treat... 

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