Glaucoma And Dry Eye Disease

Question 1

TorF: glaucoma can potentially induce reversible damage to the retina if untreated, or inadequately treated

Answer 1

FALSE. It can potentially induce irreversible damage to the retina if untreated, or inadequately treated

Question 2

Conventional Pathway:

Answer 2

exit/outflow through the trabecular meshwork (TM) ⇨

Schlemm’s Canal

Question 3

Unconventional Pathway:

Answer 3

Most common is the uveoscleral pathway: outflow through base of ciliary
muscle ⇨ uvea ⇨ sclera

Question 4

In a healthy person normal IOP is

Answer 4

~15 mm Hg

Question 5

IOP ranges from

Answer 5

Range 11 – 21 mm Hg

Question 6

Most common pathology of glaucoma is:

Answer 6

increased resistance to outflow

e.g., dysfunction of the trabecular meshwork

Question 7

Acute Angle-Closure Glaucoma:

Answer 7

Primary and secondary

Question 8

Primary AAG:

Answer 8

closure of a pre-existing narrow anterior chamber angle

Associated shallow anterior chamber (linked with far sightedness, small eye, enlargement of lens with age, inheritance)

Question 9

Closure of angle is precipitated by

Answer 9

Pupillary dilation

Question 10

Secondary AAG

Answer 10

May occur in anterior uveitis

With dislocation of lens

Question 11

TorF: secondary AAG does not require a pre-existing narrow angle

Answer 11

True

Question 12

Chronic glaucoma is characterized by ___________ of the optic disk with loss of vision

Answer 12

gradual progressive excavation (cupping)

Question 13

In chronic Open-angle glaucoma (primary or secondary), IOP is _________ due to __________ drainage of AH through the trabecular
meshwork

Answer 13

In chronic Open-angle glaucoma (primary or secondary), IOP is
ELEVATED due to REDUCED drainage of AH through the trabecular
meshwork

Question 14

TorF: Primary (chronic) open-angle glaucoma is usually bilateral

Answer 14

True

Question 15

Secondary open-angle glaucoma may result from ocular disease

such as

Answer 15

pigment dispersion, uveitis, trauma or corticosteroid therapy

Question 16

this appears as a red donut:

Answer 16

Retinal nerve fibers converge at the optic disc which forms the optic nerve

Question 17

On dilated eye exam, this appears as the white center of the donut

Answer 17

The center of the optic disc, optic cup, which is devoid of nerve fibers

Question 18

The _______ collapses under elevated IOP, pinching blood vessels and nerve fibers

Answer 18

Lamina cribosa

Question 19

A major pharmacological strategy employed in treating glaucoma is focused on lowering IOP via:

Answer 19

Decreasing AH production from the ciliary processes

Increasing AH outflow from conventional or uveoscleral pathways or remodeling of the trabecular meshwork cytoskeleton)

Question 20

What is the MOA of prostaglandin analogs?

Answer 20

Binds to prostaglandin FP receptors to cause an increase in AH outflow ‘ from the uveoscleral pathway via:

Relaxation of ciliary smooth muscles

Cytoskeletal alteration leading to change in shape of cells

Remodeling of extracellular matrix of the uveoscleral pathway by
increasing matrix metalloproteinases

Question 21

Ocular side effects of latanoprost:

Answer 21

blurred vision

conjunctival hyperemia

foreign body sensation

itching

Increase ocular pigmentation (e.g., iris, eyelid and eyelashes)

photophobia

Question 22

Latanoprost is used for the treatment of:

Answer 22

open-angle glaucoma and

ocular HTN

Question 23

LATANOPROSTENE BUNOD

Answer 23

A nitric oxide (NO)-donating prostaglandin F2α analog

Question 24

What is the MOA of lantanoprostene bunod ?

Answer 24

Dual mechanism of action:

*Increasing AH outflow from uveoscleral pathway

• Increasing AH outflow from trabecular meshwork pathway
  mediated by NO (lantanoprost does not have this MOA)

Question 25

What is the MOA of BETA-ADRENOCEPTOR BLOCKERS

Answer 25

Lower production of AH from the ciliary epithelial cells of the ciliary processes leading to decreased inflow into the posterior chamber.

Question 26

Ocular side effects of timolol include:

Answer 26

irritation, photophobia, eyelid | erythema, epiphora (Excessive watering of the eye)

Question 27

Systemic side effects of timolol are:

Answer 27

Systemic side effects include bradycardia, arrhythmias, | hypotension, bronchospasm and heart failure

Question 28

TorF: Timolol is used for the treatment of open-angle glaucoma

Answer 28

True

Question 29

TorF: BETAXOLOL is a cardioselective B1 blocker

Answer 29

True

Question 30

BETAXOLOL can be used for:

Answer 30

open-angle glaucoma and ocular hypertension

Question 31

MOA of a2 agonist:

Answer 31

* Leads to an INCREASE in both intracellular and aqueous humor CAMP levels and INCREASE in AH outflow facility * Leads to VASOCONSTRICTION and REDUCED AH production

Question 32

Brimonidine is used:

Answer 32

Used in the treatment of open-angle glaucoma and ocular | hypertension

Question 33

PARASYMPATHOMIMETICS Acts by increasing AH outflow via two mechanisms:

Answer 33

*Activation of muscarinic receptors in scleral spur and the ciliary muscle to cause contraction leading to an increase in aqueous humor outflow *Activation of muscarinic receptors in the iris to cause contraction (miosis) which can relief the narrowing of the anterior chamber angle

Question 34

___________ is a cholinesterase inhibitor which acts by increasing the concentration of acetylcholine at muscarinic receptor sites

Answer 34

Ecothiophate

Question 35

PILOCARPINE is used in the tx of:

Answer 35

open-angle glaucoma

Question 36

ECOTHIOPHATE is used in the tx of

Answer 36

reduction of elevated intraocular presssure

Question 37

CARBONIC ANHYDRASE INHIBITORS MOA:

Answer 37

* Acts by inhibiting carbonic anhydrase isoenzymes present in the ciliary processes leading to a REDUCTION of bicarbonate and AH SECRETION. AND * A decrease in AH secretion will cause a decrease in AH inflow into the posterior chamber.

Question 38

ACETAZOLAMIDE is used in the tx of:

Answer 38

adjunct in open-angle glaucoma

Question 39

Inhibition of rho kinase reduces intraocular pressure via:

Answer 39

* lowering of outflow resistance in the trabecular meshwork leading to enhanced outflow of AH from the eye * Decreasing AH production * Decreasing episcleral venous pressure

Question 40

NETARSURDIL is used in the tx of:

Answer 40

open-angle glaucoma and ocular hypertension

Question 41

What is the function of the tears?

Answer 41

 Makes cornea a smooth optical surface by covering minor surface epithelial irregularities  Moisten and protect corneal and conjunctival epithelium  Inhibit the growth of microorganisms by mechanical flushing and antimicrobial action  Provide nutrition for the cornea  Maintain ocular tissues; support wound healing

Question 42

The outermost lipid layer:

Answer 42

Seal the tear film and prevent evaporation of aqueous layer

Question 43

The middle aqueous layer:

Answer 43

Produced by lacrimal glands and accessory glands Contains water-soluble substances: electrolytes; proteins; immunoglobulins; nutrients Lubricate eye, prevent infection, flush particles from eye, nourish cornea

Question 44

Dry Eye Disease Definition:

Answer 44

Dry eye is a multifactorial disease of the ocular surface characterized by: *a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage,and neurosensory abnormalities play etiological roles.

Question 45

What is the most common cause of evaporative dry eye?

Answer 45

Meibomian Gland Dysfunction

Question 46

Artificial tear substitutes are _______ or __________ solutions composed of electrolytes, surfactants, preservatives, and some viscosity-increasing agent that prolongs the residence time in the cul-de-sac and precorneal tear film.

Answer 46

hypotonic or isotonic

Question 47

MOA of ANTI-INFLAMMATORY IMMUNOMODULATORS

Answer 47

A calcineurin inhibitor that exerts immunomodulatory action by blocking T cell infiltration, activation and subsequent release of inflammatory cytokines and chemokines (IL-1β, TNF-α, IL-6, intercellular adhesion molecule-1, and vascular cell adhesion molecule-1)  Cyclosporine A also inhibits p38 and JNK activation that leads to IL-2 production. Reduced IL-2 levels further blocks the function of effector T cells

Question 48

PHARMACOLOGICAL ACTIONS of CYCLOSPORINE A

Answer 48

Increases tear production in patients with dry eye disease that are refractory to conservative treatments such as ocular lubricants Protects human conjunctival epithelial cells via its antiapoptotic actions Improves conjunctival goblet cell density and corneal surfact integrity via its immunomodulatory actions

Question 49

CYCLOSPORINE A is used in the tx of:

Answer 49

*Ocular side effects include instillation site pain, conjunctival hyperemia, blepharitis, eye irritation *Systemic side effects include urinary tract infection, headache ``` *Used to increase tear production in adults with keratoconjunctivitis sicca (dry eye) ```

Question 50

Lifitegrast _____ T cell migration, activation and release of proinflammatory cytokines

Answer 50

Inhibit

Question 51

LIFITEGRAST is used for the tx of:

Answer 51

Used for the treatment of signs and symptoms of dry eye disease

Question 52

This drug is a corticosteroid that reduces the inflammatory processes associated with dry eye disease

Answer 52

LOTEPREDNOL