Internal Medicine

0521779407-08 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:47

628 Glaucoma

■Lower intraocular pressure to “safe” level

■Stabilize – vision loss from glaucoma cannot be cured or repaired

specific therapy

■Indicated in most glaucomas where risk of progression is high

■Medications, laser or surgery are all options

■80% with open angles receive only eyedrop therapy

■Laser iridotomy is initial therapy if angle closure

■Therapy is increased step-wise to obtain target pressure and ideally

stop disease progression

■Because target pressure is arbitrary and the disease progression often

slow, long follow-up is required to assess efficacy of treatment.

Medical Therapy

■Prostaglandin derivatives (bimatoprost, latanaprost, travaprost

and unoprostone)

➣Strongest once-daily therapy (bimatoprost, latanaprost, trava-

prost)

➣Outflow agent

➣Side effects & contraindications

Red eyes, keratitis, rarely myalgias

Increased iris pigmentation in hazel eye

Increased lash growth

Relatively contraindicated in postoperative glaucomas and H.

simplex keratitis patients

■Beta-blockers (timolol, Betaxolol, levobunolol, etc.)

➣Once or twice daily, inflow agent and strong

➣Many more serious potential side effects

➣Side effects & contraindications

Contraindicated in asthma and 2d-3d degree heart block

fatigue, impotence, depression, confusion and memory loss

➣Betaxolol is only beta-I selective and can be used in asthmatics

and COPD; not as strong as non-selectives and is BID

■Alpha-agonists (apraclonidine, iopidine)

➣Good pressure lowering affecting outflow and inflow

➣Favorable toxicity profile

➣Side effects & contraindications

Contraindicated in babies and children

Dry mouth and hypotension

Fatigue syndrome prominent but rare

Allergic reactions 10–30% with this medication