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Glaucoma
Glaucoma is characterized by
progressive visual field loss caused by nerve damage from increased intraocular
pressure.
A. Open-angle glaucoma is the most common form of glaucoma and is caused by a
malfunction of the trabecular meshwork despite normal angle structures by
gonioscopic examination. It is asymptomatic, and the etiology is
multifactorial. Risk factors associated with an increased tendency toward the
development of open-angle glaucoma include a family history of the disease,
age, black race, diabetes, hypertension, and myopia. Treatment includes topical
cholinergic or adrenergic agonists, b-adrenergic antagonists, topical carbonic
anhydrase inhibitors (brinzolamide, dorzolamide), and topical prostaglandin
inhibitors (latanoprost). Systemic carbonic anhydrase inhibitors can be added
if topical agents do not reduce intraocular pressure adequately.
B. Angle-closure glaucoma results from obstruction of the outflow of aqueous
humor through the trabecular meshwork. Common signs include conjunctival
hyperemia, corneal edema, and a fixed middilated pupil. An acute rise in
pressure may result in pupil dilatation; eye or face pain, or both; nausea;
vomiting; loss of visual acuity; and/or seeing colored halos around lights. An
acute angle-closure attack should be treated promptly in coordination with an
ophthalmologist. Therapeutic agents include acetazolamide, 250 mg
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