It may be

1. It may be

2. Drugs usedfor glaucoma

3. Glaucoma: i.o.t>21mmHg • Normal intraocular tension : 10-21mmHg

4. The concept of glaucoma: • Glaucoma is a group of diseases that can damage the eye's optic nerve and result in vision loss and blindness.

5. However, with early treatment, you can often protect your eyes against serious vision loss.

6. The damages are mostly caused by increased pressure of aqueous humor in the eye

7. Glaucoma: Symptoms Reduced side vision, central vision intact Tunnel vision Normal vision

8. Glaucoma: Symptoms Halo around lights SYMPTOMS Red eye, pain in the eye, Blurred vision Tunnel vision Vision loss

9. What is Optic Nerve? “Cable “that transmit image signals to brain

10. Glaucoma damage formation

11. Higher IOT is the most important cause leading to the damage pressure What causes optic nerve injury in glaucoma？ Two causes : Mechanical forces (intraocular tension and vascular forces ) Optic nerve

12. Anterior chamber;Posterior chamber;pupil;Iris; Anterior chamber angle; Cornea;ciliary body;

13. Who is most likely to get glaucoma? You are more likely to get glaucoma if you: • Have family members with glaucoma • Are over 45 years • Have poor vision • Have diabetes • Take steroid medication • Previous eye injury.

14. Open angle glaucoma • Angle closure glaucoma Glau-coma

16. Classification on Mechanism

17. Aqueous FluidNormal Drainage: good flow The meshwork– is the eye’s drain anterior chamber angle The Ciliary Body– When this drainage of the fluid gets blocked, excess pressure is formed leading to Glaucoma

18. Normal drain

19. Closed-angle Glaucoma anterior chamber angle Blocked Drainage holes The angle is narrower than normal. If water can’t flow easily through the opening in the pupil, the iris pushes forward and blocks the drainage holes.

20. Closed-angle glaucoma

21. Closed-angle Glaucoma • The drainage angle of trabecular meshwork becomes blocked by the iris I.O.t builds up very fast.

22. Symptoms include severe eye or brow pain, redness of the eye,decreased or blurred vision. • Must be treated as a medical emergency—see your ophthalmologist immediately

23. Open Angle Glaucoma anterior chamber angle Clogged Drainage holes The angle between the iris and the cornea is normal, but the drainage holes get clogged from the inside.

24. Open Angle Glaucoma

25. How can I find out if I have glaucoma? A series of test performed by your eye doctor will help to determine whether you have glaucoma or likely to develop glaucoma.

26. How is glaucoma treated?

27. Will I go blind because of glaucoma? If glaucoma is left untreated, damage increases, which may eventually lead to blindness.

28. Treatment Options Pills Eye drops Combination method Laser surgery Eye operations

29. The purpose of treatment is to prevent further loss of vision. • This is important because loss of vision due to glaucoma is irreversible.

30. Therefore, you should have Regular eye examinations Regular intake of medications as instructed by the eye doctors

31. Commonly used drugs: • 1. Cholinergic agonists • 2. ß- adrenal receptor blockers • 3. -adrenal agonists • 4. Prostaglandins • 5. Carbonic Anhydrase Inhibitors • 6. Hypertonic agent

32. Cholinergic agonists • .

33. Parasympathetic-constricts pupil M  circularmuscle Radial muscle

34. Aqueous humor flow Aqueous humor flow Aqueous humor flow Aqueous humor flow Aqueous humor flow Aqueous humor flow

35. Cholinergic agonists • causes pupillary sphincter and the ciliary muscle contraction open corner aqueous humor outflow from the trabecular meshwork

36. Aqueous humor flow Pilocarpine, an acetylcholine mimetic, is used to stretch the trabecular tissues to allow the aqueous humor to flow out through the schlemm’s canal.

37. Miotics--- Pilocarpine • Several drawbacks ,they are used only as the last option. • By increasing ciliary muscle tone improving patency of trabeculae

38. ß- adrenal receptor blockers one of first line drugs

39. ß- adrenal receptor blockers • Decrease aqueous production down regulation of adenylylcyclase due to ß2–R blockade in the ciliary epithelium ocular blood flow

40. Timolol maleate (Timoptic), levobunolol (Betagan)(lipophilic with high ocular capture and no local anaesthetic activity)

41. ß2–R antagonists may be used for open angle glaucoma since these agents reduce the production of vitreous fluid.

42. ß- adrenal receptor blockers • Advantages: • NO change in pupil size • No induced myopia • No headache • No fluctuations in i.o.t

43. ß- adrenal receptor blockers • ADR(mild and infrequent) • Stinging ,redness and dryness of eyes • Corneal hypoesthesia

44. Timolol • The ocular hypotensive action is smooth and well sustained. • After chronic use ,effect on i.o.t persists for 2-3weeks following discontinuation. • This feature gives high clinical safety

45. ß- adrenal receptor blockers • Can have systemic beta blockade effects

46. levobunolol • The ocular and systemic effects are similar to timolol • But longer duration of action than timolol

47. Topical alpha adrenergic agonists • Decrease aqueous production • Ex: alphagan

48. adrenaline • Due to poor corneal penetration,the response is variable. • uveoscleral outflow and ß2–R mediated increased hydraulic conductivity of trabecular filtering cells.

49. adrenaline • in aqueous formation can result from 1 and 2 receptor activation in ciliary body

50. adrenaline • Not used because of ocular intolerance and possible systemic