1What is Glaucoma?
A chronic progressive optic neuropathy characterized by damage to the optic nerve head (ONH) and retinal nerve fiber layer (RNFL)
(characterized by increased Intraocular pressure IOP)
2Intraocular pressure is normally ______ +/- 2.5 mmHg
15.5
3Describe Open Angle Glaucoma (OAG)
trabecular meshwork is blocked, causing aqueous humor to drain from the anterior chamber too slowly, increasing IOP.
4Describe Closed Angle Glaucoma (ACG)
The angle leading up to the trabecular meshwork is too acute to allow aqueous humor to reach the trabecular meshwork and be drained from the anterior chamber, increasing IOP.
5(Open/Closed) angle glaucoma is the most common (95%)
Open
6(Open/Closed) angle glaucoma is more predominat in people of asian descent.
Closed
7What drugs may increase IOP?
- Anticholinergics & Antihistamines
- Steroids
- SSRIs
- TCAs
- Topiramate
8IOP can be lowered in what 2 ways?
- decreasing aqueous humor production
- increasing aqueous humor outflow
9First line medications for Glaucoma
- Prostaglandin analogs
- NS Beta Blockers
10Second line medications for Glaucoma
- Brimonidine (alpha 2 agonist)
- Carbonic anhydrase inhibitors
11Third line medications for Glaucoma
- Latanoprostene bunod
- Netarsudil
12No more than 1 medication should ever be initiated for glaucoma (True/False)
False (2-4 meds may be required to reach desired IOP)
13What are the Prostaglandin analogs?
"BLT"
- *Bimatoprost*
- *Latanoprost*
- Latanoprostene bunod
- *Travoprost*
- Tafluprost
14Prostaglandin analog MOA in Glaucoma
Increase aqueous humor outflow
15Adverse Effects associated with Prostaglandin analogs
- iris color change
- Eye redness
- Eyelid/ brow darkening
- Periorbital fat loss
- Eyelash growth
16Which Beta Blockers are indicated for Glaucoma?
- Betaxolol
- Carteolol
- Levobunol
- Metipranolol
- Timolol
17Of the Beta Blockers indicated for Glaucoma, Which is NOT nonselective?
Betaxolol
18What is the MOA of Beta Blockers in Glaucoma?
Decrease aqueous humor production
19Adverse effects associated with Beta Blockers
- Bradycardia
- Bronchospasm
- Depression
- Exercise intolerance
- Hypotension
- Impotence
- Masked hypoglycemia
20What are Contraindications for Beta blockers?
- Asthma/COPD
- HF
- Bradycardia (< 60 bpm)
- Hypotension
21What are the Alpha 2 agonists indicated for Glaucoma?
- Brimonidine
- Apraclonidine
22What is the MOA of alpha 2 agonists in glaucoma?
Reduce rate of aqueous humor production and enhance its outflow
23Adverse Effects associated with Alpha 2 agonists
- Allergic reactions
- Hypotension
- Dry mouth
- Fatigue
- HA
- Somnolence
24What is a contraindication for Alpha 2 agonist use?
- Concurrent MAOI use
25What are the Carbonic Anhydrase Inhibitors (CAIs) indicated for Glaucoma?
- Brizolamide
- Dorzolamide
- Acetazolamide
- Methazolamide
26What is the MOA of Carbonic Anhydrase inhibitors in Glaucoma?
Decrease aqueous humor production by blocking Na+ & Bicarb secretion
27Adverse Effects associated with CAI use
- Burning
- Corneal edema
- Metallic taste
- Conjunctivitis
28What cholinergics are indicated for Glaucoma?
- Carbachol (agonist)
- Pilocarpine (agonist)
- Echothiophate (AChE inhib)
29What is the MOA of Cholinergics in Glaucoma?
Improve trabecular outflow of aqueous humor
30Adverse effects associated with Cholinergic use
- Bronchospasm
- Brow ache
- Abdominal cramps
- Miosis
- Myopia
- Retinal detachment
31Contraindications to cholinergics
Neovascular, Uveitic, or Malignant glaucoma
32What are the Rho Kinase Inhibitors indicated for Glaucoma?
Netarsudil
33What is the MOA of Rho Kinase inhibitors in Glaucoma?
Increase aqueous humor outflow from trabecular meshwork
34Adverse effects associated with Rho Kinase Inhibitors
- Conjunctival redness
- Corneal verticillata
- Instillation site pain
- Conjunctival hemorrhage
35What is Age-Related Macular Degeneration (AMD)?
Neurodegenerative disease that damages the macula
36Risk factors for AMD
Age & Smoking
37Hallmark sign of AMD
Development of drusen (yellow lipids) in the macula
38Dry vs Wet AMD
*DRY*
- macula gets thinner with large yellow deposits of drusen in macula
*WET*
- growth of abnormal blood vessels that leak blood which damages the macula
39AMD Treatment
- Smoking cessation
- Antioxidants & Vitamins (AREDS)
- anti-VEGF (Wet)
40anti-VEGF agents are administered via what route?
intravitreal
41For Wet AMD, are mAb or non-mAb VEGF inhibitors preferred?
mAb is preferred
42What is Dry Eye Disease?
Tear film is compromised leading to dry eyes
43What Meds may induce Dry Eye Disease
"ABCDs"
- ɑ-1 antagonists
- ɑ-2 agonists
- anticholinergics
- anticonvulsants
- antidepressants (TCAs)
- antihistamines
- antimalarials
- antineoplastics
- antipsychotics
- anxiolytics
- β-agonists and antagonists
- bisphosphonates
- cannabinoids
- contraceptives
- decongestants
- diuretics
44DED Treatment
*Ophthalmic medications*
- Topical lubricants
- Anti-inflammatory
- LFA-1 antagonists
- Cholinergic agonists
*Punctal occlusion*
45Topical lubricants are AKA:
Artificial tears
46First line agents for DED
Topical lubricants (more severe cases may require adjuncts)
47What anti-inflammatory agents are used for DED?
- Cyclosporine
- Lifitegrast
- Loteprednol
48What cholinergic agonist is used for DED?
- Varenicline
49What is Conjunctivitis?
Inflammation/infection of the conjunctiva (Pink Eye)
50Conjunctivitis Treatment
*Symptomatic treatment*
- Lubricant eye drops
- Topical decongestant/antihistamine
*Allergic*
- Antihistamine or mast cell stabilizer
51(Bacterial/Viral) conjunctivitis causes sticky pus.
Bacterial
52(Bacterial/Viral) conjunctivitis requires no treatment
Viral
53What is Thyroid Eye Disease (TED)?
Immune system attacks tissues around eyes causing bulging
54TED Treatment
Teprotumumab (insulin-like GF)