C i.e. Acetazolamide - Acetazolamide is a diuretic (carbonic anhydrase inhibitor) used in glaucoma systemically. The topical counter pa is dorzolamideQ. All diuretics except mannitol and ethacrynic acid are contra indicated in patients with sulfa allergyQ. - Adrenergic drugs apraclonidine & brimonidine cause drowsinessQ Anti-Glaucoma Drugs Surgical Management Group Drugs Mechanism Ocular S/E Systemic S/E Contraindications Topical Laser Trabeculoplas Adrenergic * i3 blocker Reduce aqueous Allergic ble Bronchospasm, AsthmaQ, COPD, Antagonist (Non-selective) - Timolol Q secretion by cilliary body * pharoconj unctivitis Q. bradycardia, decreased CHF, Sinus bradycardia, AV ty - Levobunolol - Caeolol - Metipranolol - Adaprolol Non-selective 0 blockers are more effective in lowering the lOP Blurred vision / Burning, Corneal hyposthesiaQ, Dryness of eyes,Super- ficial punctate keratitis / Stinging & redness cardiac output, hypotension, depression, impotence, altered lipid profileQ block * Using Argon or Diode or Double frequency Nd:YAG LASER * Not used for solo or primary * l, blocker (selective) - Betaxolol Betaxolol is also thought to increse perfusion of the optic nerve head Stinging, local anaesthesia Less pulmonary side-effects Sinus bradycardia, AV block therapy as IOP reduction is seldom Adrenergic * Non-selective Reduce aqueous Follicular Increase in blood Angle closure >30% Agonist - EpinephrineQ - Dipivefrine Q secretion by cilliary body conjunctivitis, rebound pressure, Q arrhythmias glaucoma, Cardiovascular * Reserved for following Increase uveo- scleral outflow Possibly increases the trbecular out flow congestion, macular oedema in aphakes disease cases - Inadequate response to drug therapy Dipivefrine is a prodrug, conveed to epinephrine inside the eye, reducing local/systemic toxicity - Patient not compliant - As an adjuvant to drug - Avoidance of surgery * ai+a2-Selective -ApraclonidineQ Allergies, fluctuation in visual acuity Headache, drowsiness, Q fatigue Use of MAO inhibitors, Parkinonsonism Trabeculecto my , Hypetensive *Indications: * az-Selective Conjunctival crisis - Failed -BrimonidineQ -Clonidine blanching, ocular allergy DrowsinessQ, fatigue, blood pressure changes Same as above medical therapy & LASER Miotics Pilocarpine Q Improve trabecular Fluctuating and Increased Uveitis trabeculopla (Direct para sympatho- mimetics) PhysostigmineQ Ecothiophate Carbachol Demecarium outflow by contracting the cilliary muscles pulling the scleral spur blurred vision, miosis, browache, accommodative spasm sweating and salivation, urinary frequency, diarrhoea, bronchospasm sty - Pt not suitable for LASER therapy Prosta- glandin Latano/Bimato/ Travo-prost Increase uveo- scleral outflow Iris pigmentation, punctate keratitis Ocular inflammation/ - Eyes with very Analogue Isopropyl- unoprostone infection advanced disease Carbonic DorzolamideQ Block Carbonic Anhydrase Inhibitors AL 4333 A Anhydrase & reduce aqueous production Systemic * Ceain Anti - Carbonic A cetazolamideQ Block Carbonic Punctate keratitis, Bitter taste, Hypersensitivity Anhydrase Inhibitors Dichlorphen- amide Anhydrase & reduce aqueous ocular allergies headache, asthenia, renal to sulfa drugsQ, eye injury glaucoma drugs such as Methazolamide production calculi memantine Hyper- osmotic agents MannitolQ Increase serum osmolality,causing water to leave viterous cavity, reducing the TOP Iris pigmentation, Punctate keratitis Headache, symptoms of upper respiratory tract infection Hypeension, pulmonary edema, cardiac/renal failure are being evaluated for their efficacy in protecting retinal ganglion cells. Glycerol Diabetes