Drugs for Glaucoma & Adverse effect_22 May 2024

Drugs for glaucoma

1. Drugs For Glaucoma

2. Glaucoma is group of eye disorders that damage your optic nerve which leads to vision loss associated with raised Intra Ocular Pressure. (Normal-10—20 mm Hg) Types Open Angle Closed Angle/Narrow/Acute Congenital Normal Tension < Angle between Iris and Cornea Flow of aqueous humor Symptoms Eye pain or pressure. Headaches. Rainbow-colored halos around lights. Low vision, blurred vision, narrowed vision (tunnel vision) or blind spots. Red eyes. Risk Factors BP, Diabetes, Eye injury Surgeries

3. DIAGNOSTIC TESTS Dilated eye exam to widen pupils and view your optic nerve at the back of your eyes. Gonioscopy to examine the angle where your iris and cornea meet. Optical coherence tomography (OCT) to look for changes in your optic nerve that may indicate glaucoma. Ocular pressure test (tonometry) to measure eye pressure. Pachymetry to measure corneal thickness. Slit-lamp exam to examine the inside of your eye with a special microscope called a slit lamp. Visual acuity test (eye charts) to check for vision loss. Visual field test (perimetry) to check for changes in peripheral vision (your ability to see things off to the side).

4. Management of Glaucoma Prevention, Laser Surgery, MIGS (Minimally Invasive Galucoma Surgery) Pharmacological Management is - Decreasing IOP, Improving drainage or decreasing the formation of aqueous humor. 1. Osmotic agents : Mannitol (20%) i.v. infusion (1.5 g/kg body weight) 50% glycerol oral (1.5 g/kg) are used. They draw fluid from the eye into the circulation by osmotic effect and reduce 2. Carbonic anhydrase inhibitors: Acetazolamide (oral, i.v. ), D orzolamide (topical) and brinzolamide (topical) . They inhibit carbonic anhydrase enzyme, decrease bicarbonate formation in ciliary epithelium and decrease the formation of aqueous humour . Topical carbonic anhydrase inhibitors are preferred.

5. 3. Beta Adrenergic blockers: Topical nonselective beta -blockers are Timolol, betaxolol , levobunolol and carteolol . They decrease aqueous humour formation by blocking Beta 2-receptors on ciliary epithelium. Beta2-Blockers also decrease ocular blood flow. Timolol is widely used in glaucoma because ( Topical timolol is safer and highly effective) it lacks local anaesthetic or partial agonistic properties; (ii) it does not affect pupil size or accommodation; (iii) it has longer duration of action; (iv) it is well tolerated; (v) it is less expensive. Betaxolol is a selective Beta1-blocker used in glaucoma, but it is less effective than nonselective agents. Betaxolol is protective to retinal neurons. Levobunolol is long acting. Beta -Blockers should be cautiously used in patients with bronchial asthma and heart failure

6. 4. Prostaglandins (PGs): They reduce IOP probably by facilitating uveoscleral outflow. Topical PGs such as L atanoprost, T ravoprost and B imatoprost (PGF2 alpha-analogues) D rug of choice in open-angle glaucoma because of T heir longer duration of action (once a day dosing), High efficacy and L ow incidence of systemic toxicity. They are also useful in acute congestive glaucoma. Latanoprost is also available in combination with timolol. They usually do not cause systemic side effects B ut may cause ocular irritation and iris pigmentation. 5.Miotics: Pilocarpine is a tertiary amine and is well absorbed through cornea. It is used topically in the treatment of open-angle and acute congestive glaucoma . It facilitates drainage of aqueous humour and reduces IOP.

7. 6 . Alpha Adrenergic agonists: They are used topically as an adjunct , don’t cross BBB, acts on alpha 2 receptor present in Ciliary epithelium a) Apraclonidine, Brimonidine – Reduces formation of aqueous humuor and decreased IOP. b) Dipivefrine – Prodrug of adrenaline, Penetrates Cornea and with help of esters converted to adrenaline.

8. THANK YOU