Ophthalmology Part II

Question 1

Differences between closed angle and open angle glaucoma

Answer 1

Closed angle
- pressure pushes iris against cornea
- drainage is completely blocked
Open angle
- obstructed drainage of canal
- drainage is slower than usual due to blockage

Question 2

Risk factors of glaucoma

Answer 2

• age greater than 40
• Asian (2%), African American ( 7-8%)
• corneal thickness
• Eye injury
• Use of steroids
• Nearsighted or farsighted
• High blood pressure
• Sickle cell anemia
• Diabetes

Question 3

Symptoms of open-angle glaucoma

Answer 3

• No symptoms in early stages
• patchy blind spots in peripheral vision
• Difficulty seeing in central vision

Question 4

Diagnosis of open angle glaucoma

Answer 4

• measuring intraocular pressure
• testing for optic nerve damage
• checking for vision loss
• measuring corneal thickness
• inspecting drainage canal

Question 5

Open angle treatment goals

Answer 5

1. Reduce aqueous humor production
   - can be done with drugs like beta blockers and carbonic anhydrase inhibitors
2. Increase aqueous humor
   - prostaglandin analogs, cholinergics, and Rho kinase inhibitors

Drugs that can do both
- alpha 2 agonists

Question 6

1st line treatment
Prostaglandin Analogs
Drugs
Warning and Side effects

Answer 6

Bimatoprost (lumigan)
Travoprost ( Travatan z, Travatan)
Latanoprost ( Xalatan, Xelpros)
Tafluprost (Zioptan)
Bimatoprost ( Latisse)

Warnings
- Darkening of Iris, eyelid, skin, and eyelash
- increase in eyelash length and number

Side effects
- Blurred vision
- Stinging
- Increased pigmentation of Iris/ eyelashes
- Eyelash growth/thickening
- Light sensitivity
- Foreign body sensations

Question 7

1st line treatment
Beta Blockers drugs
Warnings and side effects

Answer 7

Nonselective drugs:
- Timolol (timoptic, timoptic- XE, istalol)
- Carteolol
- Levobunolol (betagan)
Selective drug:
- Betaxolol (betoptic S)

Warning:
Sinus Bradycardia
second or third degree heart block
cardiogenic shock
uncompensated cardiac failure
Bronchospastic disease

Side effects:
Stinging
blurred vision
bradycardia
breathing problems
hypotension
dizziness
fatigue
impotence

Question 8

Alternative 1st/2nd line
Alpha 2 agonists drugs
warnings and side effects

Answer 8

Brimonidine (alphagan P)
Brimonidine and timolol (combigan)
Brimonidine and Brinzolamide (simbrinza)
Apracholonidine (Lopidine)
Brimonidine (lumify)

Warnings:
CNS depression

Side effects:
Dry eyes
Xerostomia
Blurry vision
Conjunctival hyperemia
Sedation
Confusion

Question 9

2nd line
carbonic anhydrase inhibitors

Answer 9

Ophthalmic
Drozolamide (trusopt)
Drozolamide and timolol (cosopt, cosopt PF)
Brinzolamide (azopt)
Brinzolamide and brimonidine (simbrinza)

Ophthalmic side effects
burning
blurred vision
blepharitis
taste disturbance

Oral:
acetazolamide
methazolamide

Oral side effects
ataxia
confusion
photosensitivity
nausea
metabolic acidosis

Question 10

3rd line
rho kinase inhibitors

Answer 10

Netarsudil (rhopressa)
Netarsudil and latanoprost (rocklatan)

Side effects
Burning
Corneal disease
Conjunctival hemorrhage
conjunctival hyperemia

Question 11

Last line
cholinergics
Warnings and side effects

Answer 11

Carbachol (milostat)
Pilocarpine (isopto carpine)

Warning
- use in caution in patients with history of retinal detachment or corneal abrasion

Side effects: pupil constriction, corneal clouding, hypotension, bronchospasm, abdominal cramps

Question 12

Dosing for patient

Answer 12

Start with first line medication
- prostaglandin analog, beta-blocker

If patient has inadequate response?
if No response –> use different 1st line option
Partial response –> add additional 1st or second line option

If patient still has inadequate response?
Increase concentration/frequency
Add 3rd and/or 4th line agent
Consider replacing topical CAI with oral CAI