Glaucoma- Investigations And Treatment
Dr Sachine (Eye Retina Surgeon)
This resource gives information about glaucoma & its treatment
Glaucoma is a progressive optic neuropathy characterized by visual field loss for which increased intraocular pressure is a risk factor.
Glaucoma is a very slowly progressing condition which affects peripheral vision first & central vision generally remains good till end stage. Intraocular pressure ( IOP) is also one of the factors important in glaucoma. IOP has to be recorded many times.
Suspicious findings like increase in cup disc ratio, rise in intraocular pressure, etc will make your doctor suspect whether you have glaucoma . Tests like gonioscopy, optical coherence tomography for retinal nerve fibre layer, Humphrey visual field test, pachymetry for central corneal thickness have to be done to confirm diagnosis.
Commonly used antiglaucoma medicines and eye drops
. Timolol maleate 0.5% eye drops ( Trade name- timolet)- Daily twice instillation
. Latanoprost (Trade name- Latoprost) – Convenient dose- only at night
. Brimonidine (Trade name- brimosun-p)- Daily twice instillation
. Dorzolamide(Trade name- dorzox)- Daily thrice instillation
. Travoprost(Trade name-travo)
. Pilocarpine 2%, 4% drop- (Trade name- pilocar)- Used in primary angle closure glaucoma
. Neuroprotective eye drops- Brimonidine
. Tablet acetazolamide (Trade name- diamox )- Depending on intraocular pressure, dose is adjusted as one, 2,3 or 4 tablets / day.
. Mannitol- It is given intravenous in cases of acute rise in intraocular pressure. Acute rise in intraocular pressure can occur in primary angle closure glaucoma, after eye injury, etc. Mannitol is very useful in reducing pain in such cases
Combination eye drops
These are more convenient for patient.
. Brimonidine+ Timolol (Trade name- brimolol)
. Latanoprost+ Timolol (Trade name- Latocom )
. Bimatoprost(Trade name-lumigan)
Side Effects of antiglaucoma medicines and eye drops
.Timolol- It can cause bronchospasm. To be avoided in asthmatics & heart disease cases especially those who have heart block.
It reduces libido. So to be avoided in young sexually active males.
. Latanoprost- Pigmentation over iris,conjunctiva, below lower eyelid & cheek, increase in length of eyelash
. Pilocarpine- Induced myopia, headache
. Travoprost- Allergic reaction, redness of eye, etc.
. Acetazolamide- Gastritis- To avoid this, it is to be taken after food, with milk or with antacid.
Tingling numbness due to potassium deficiency. To avoid this, syrup kesol is given
. Oral glycerol- Blood sugar can rise. So to be avoided in diabetes.
. Mannitol-To be avoided in heart disease cases as it can increase cardiac overload and precipitate heart attack.
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