Glaucoma examination

When a -adrenergic blocking ophthalmic preparation, such as timolol, is administered to patients with glaucoma, it is important to insist that they have periodic follow-up examinations by an ophthalmologist. At these examinations, the intraocular pressure should be measured to determine the effectiveness of drug therapy. 

GLAUCOMA Before Hierapy for glaucoma is started, Hie primary healHi care provider thoroughly examines Hie ey The nurse reviews Hie primary health care provider s diagnosis and comments, takes a general patient health... 

These drugs dilate the pupil (mydriasis), constrict superficial blood vessels of the sclera, and decrease the formation of aqueous humor. Depending on the specific drug and strength, these dru may be used before eye surgery in the treatment of glaucoma, for relief of minor eye irritation, and to dilate the pupil for examination of the eye... 

It is approved for mydriasis in ocular examination and surgery and for the early diagnosis of glaucoma. 

In another study, treatment for 2 years with fluticasone propionate (500 micrograms bd) had no significant effect on ophthalmic parameters (glaucoma and posterior subcapsular cataracts) (31). Slit lamp examinations were carried out in 157 asthmatic children treated with inhaled budesonide at a mean daily dose of 504 (range 189-1322) micrograms for 3-6 years (mean 4.4 years). Posterior subcapsular cataract due to budesonide was not detected (32). 

The doctor s examination has revealed that there is a possibility of elevating the pressure inside your eye when dilation is performed. The medical term for this eventuality is "angle closure glaucoma". Because of this possibility, once your pupil is dilated and the interior of the eye has been examined, the pressure will be checked again. Should it become elevated, it will be necessary to lower the pressure by administering eyedrops and oral medication. Afterwards, it may be necessary to refer you to an eye surgeon for treatment with a laser to prevent further occurrences of this kind. 

A beta-blocker may be used in the treatment of primary open-angle glaucoma, but these drugs are contraindicated for use in persons with chronic obstructive pulmonary disease and heart block (see Chapter 10). A careful history should be taken before initiating therapy to avoid potentially fatal ramifications. It is advisable to monitor patients who are taking beta-blockers (e.g., pulse, blood pressure) and to inquire about side effects at periodic follow-up examinations. 

Topical application of glycerin in concentrations from 50% to 100% results in a significant reduction of corneal edema within 1 to 2 minutes. Because application to the eye is painful, a topical anesthetic must be instilled before use. It is useful in ophthalmoscopic and gonioscopic examination of the eye in acute angle-closure glaucoma, bullous keratopathy, and Fuchs endothelial dystrophy. 

Methylene blue, a vital stain (Urolene blue), has properties similar to those of rose bengal. It can stain both devitalized cells and mucus and corneal nerves. It is not a specific stain when applied to the eye because the blue areas may be either cells or mucus. Clinically, methylene blue is useful for staining the lacrimal sac before dacryocystorhinostomy and outlining glaucoma filtering blebs, and it may prove useful in gonioscopic laser sclerostomy. More recently it has been used in vitro (tissue extraction and absorbance at 660 nm) to examine the effects of... 

The management of open-angle glaucoma requires periodic dilation of the pupil for fundus, optic nerve, and visual field examination. Pupillary dilation is essential for the following reasons ... 

A standard comprehensive eye examination is performed on the initial visit. If any visual field or optic nerve changes consistent with glaucoma are present, additional appropriate testing should be done to establish a diagnosis. 

The angle of the eye is examined by gonioscopy, which requires the use of special lenses. Gonioscopy is performed to rule out angle-closure or secondary causes of lOP elevation, such as angle recession, pigmentary glaucoma, and exfoliation syndrome. The peripheral contour of the iris is examined for plateau iris, and the trabecular meshwork for peripheral anterior synechiae, as well as for neovascular or inflammatory membranes. 

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