Glaucoma ppt by ved

Glaucoma is an eye disease that is often associated with elevated intraocular pressure, in which damage to the eye (optic) nerve can lead to loss of vision and even blindness. Glaucoma is the leading cause of irreversible blindness in the world.

1. GLAUCOMA Presented by Ved prakash panda M.Phar m (pharmacology)

2. Introduction Epidemiology Aetiology Pathophysiology Clinical menifestation Diagnosis Treatment CONTENT

3. Definition :glaucoma is a type of eye disorder in which the optic nerve is damaged due to increase in intraocular pressure with in the eye. The eye produce a fluid called aqueous humor, which is secreted by cilliary body, into the posterior chamber(a space between the iris and the lens),it then flows in to the anterior chamber between the iris and the cornea. From here it drains through a sponge like structure located at the base of the iris called the trabecular meshwork and leave the eye through venous circulation. INTRODUCTION

4. Anatomy of eye

5. OPEN ANGLE GLAUCOMA CLOSED ANGLE GLAUCOMA Epidemiology : 2% of people older than 40 years have open angle glaucoma and rises to almost 10% in people older than 75 years. Aetiology: In a healthy eye, the rate of secretion balance the ratio of drainage. In people with glaucoma, the drainage canal is partially or completely blocked. Fluid builds up in the chamber and this increase pressure with in the eye, causing intraocular hypertension, which is defined as pressure > 21 mm Hg. Types

6. The primary site of damage is the optic nerve leading to loss of vision. In open angle glaucoma , the angle between the cornea and iris is open. In this type the drainage system slowly get clogged overtime and thus gradual increase in pressure on optic nerve, results in dec . of peripheral vision, as the pressure increase even more, continious damage to opticnerve , which eventually leads to loss of central vision. Pathophysiology

7. In closed angle glaucoma the angle between the iris and cornea is too small, that means the passage way for aqueous humor outflow is too narrow and this is result of lens been pushed against the iris, result of this leads to blockage of drainage system. This is most serious type of glaucoma in which rapid pressure build up in the eye which can cause onset of eye pain and redness, blurry vision, headache. This may occur due to dilation of lens or pupil which cause the iris pushing forward and close the angle. closed angle glaucoma

8. Glaucoma is typically characterised by: IOP > 21 mmHg Visual field loss Glaucomatous retinal nerve damage Glaucomatous cupping (Increase in IOP pushes the optic disc back forming an cup size). In close angle glaucoma the pressure lies between 50 to 80 mm Hg. And cause cornea oedema . The pupil is vertically oval & un reactive to light and accommodation. Clinical manifestation

9. Tonometry : measure intraocular pressure. Tonography : measure the outflow of aqueous humour from the eye. Gonioscopy : is used to estimate width of the anterior chamber angle. Perimetry : diagnosis of scotoma (blind spot). Visual field testing Loking for optic nerve damage, glaucomatous cupping by imaging. DIAGNOSIS

10. PHARMACOLOGICAL TREATMENT: Main goal of drug is to decrease the pressure in the eye. Increase out flow of the aqueous humor Prostaglandin analogues: prostaglandins increase the sclera permeability to aqueous fluid so, an increase in PG activity increase out flow of aqueous fluid, thus lowering intra ocular pressure. Drugs: Latanoprost Travaprost Bimatoprost TREATMENT

11. Decrease production of aqueous humor : Beta- blockers : they decrease IOP by blockage of ciliary B-receptor, preventing the cyclic AMP induced rise in aqueous secretion. Drugs: Betaxolol , Timolol . Sympathomimet agents : Adrenaline is an alpha & beta adrenoreceptor agonist. It decrease IOP by redeucing aqueous inflow via an alpha mediated vasoconstriction in the ciliary body & increase outflow due to beta mediated dilation of the episcleral veins. Drygs used are: Apraclonidine , Brimonidine .

12. Carbonic anhydrase inhibitors: Carbnic anhydrase present with in the ciliary epithelial cells generate HCO3 ion whch is secreted into aqueous humor and it’s inhibitors inhibit this aqueous humor production. Drugs : Acetazolamide , Dorzolamide . Miotics : Miotics act to increase the outflow of aqueous humor by a stimulation of ciliary muscle and on opening of channels in the trabecular meshwork. Drugs: pilocarpine .

13. Hyper osmotic agents : This agents acts by drawing water out of the eye, thus lowering intra ocular pressure. Drugs: glycerol, mannitol . COMBINATION THERAPY: Fixed combination of timolol & dorzolamide Timolol-0.5% Dorzolamide2% Combination of timolol and lantanoprost Timolol0.5%,latanoprost0.005% ( xalacum ) Combination of timolol and brimonidin Timolol0.5% brimonidin0.2% Combination of timolol & travoprost Timolol0.5% travoprost0.004% Combination of timolol & bimatoprost Timolol 0.5% bimatoprost 0.03%

14. Laser treatment: Trabeculoplasty - opens trabecular meshwork and help to treat open angle glaucomas . Iridotomy - punches holes in Iris, which help to treat close angle glaucoma. Laser destroy cell that produce aqueous humor.