Glaucoma drops
Increase uveoscleral outflow
Reduce aqueous production
Both
Increase uveoscleral outflow:
Prostaglandin analogue - bimatoprost increase uveoscleral and trabecular outflow
Reduce aqueous production:
Beta blocker
Carbonic anhydrase inhibitor
Both
Alpha agonists
Pilocarpine mechanisms of action
Muscarinic antagonist
Ciliary msucle contraction
Pull on scleral spur and open trabecular meshwork
Constrict pupil
What is aqueous misdirection
Rare but serious cause of secondary angle closure
After intraocular surgery in pts with history of angle closure
Aqueous humour misdirected posteriorly into or behind the vitreous:
Shallowing of AC
Anteiror displacement of lens/iris diaphragm
Elevated IOP despite a patent iridotomy
Consider choroidal effusion, pupillary block or suprachoroidal haemorrhage
What is management for aqueous misdirection?
Ensure patent PI
Intensive cycloplegic therapy - atropine
Reduction of IOP with systemic/topical
YAG disruption of posterior capsule + anterior vitreous face
Trans-scleral cyclodiode photocoagulation of the ciliary body in one quadrant
Surgical (definitive treatment)
PPV + posterior capsulotomy
(+ phaco if phakic)
Aqueous humour vs plasma
AC is for of Acid and Chloride
Excess ascorbic acid, chloride and hydrogen
Lacks protein, bicarbonate
