GLAUCOMA
Glaucoma T
Aaron Courtenay MPharm, MPSNI, Locum Pharmacist
GLAUCOMA IS A COMMON CONDITION AFFECTING THE EYES, REQUIRING LIFELONG CARE FOLLOWING A DIAGNOSIS – OFTEN THIS CARE WILL INTERFACE WITH THE COMMUNITY PHARMACY TEAM, MAKING KNOWLEDGE OF THIS DISEASE STATE AN ESSENTIAL COMPONENT OF DAY-TO-DAY PRACTICE WITHIN THE PROFESSION.
he prevalence of glaucoma rises from 1-2% in people aged over 40 years to 5% in people aged over 70 years. Currently Scotland has the highest number of secondary referral services within the UK for glaucoma, and it has also been estimated that the prevalence of glaucoma across the Isles, will increase 40% by 2020.1
It has been suggested
that transferring the management of chronic glaucoma to the community setting would free up considerable number of valuable outpatient visits. It is therefore essential that pharmacy staff continue to be knowledgeable in the condition, signs and symptoms,
18 - SCOTTISH PHARMACIST
and treatment options that can be accessed by patients.
Glaucoma is defined by a disturbance in the structural or functional integrity of the optic nerve. Consequently, this causes characteristic changes to both visual field and the optic nerve, over time. There are numerous sub- types of glaucoma, and as such the term has become a commonly used umbrella for varying disease states. In many cases patients will not present with symptoms until late on in the disease process, and this is mainly due to the silent nature of glaucoma.2 The main types of glaucoma include: angle closure glaucoma, open angle
glaucoma, congenital glaucoma, and secondary glaucoma.
Glaucoma is a multifactorial disease state, and often makes it difficult to define the condition in each patient. In general, glaucoma involves one or more of the following conditions:
• Increase in intraocular pressure
• Abnormalities in the aqueous drainage system form the eye
• Damage to the optic disc • Loss of visual field
ANGLE-CLOSURE GLAUCOMA Angle-closure glaucoma (also refereed to as acute glaucoma) is a condition in which the iris is pulled anteriorly, blocking the trabecular meshwork – this results in reduced outflow of aqueous humour from the eye, which in turn significantly increases intraocular pressure. Chronic open- angle glaucoma is more common in patients who are long-sighted, as
their anterior chambers are slightly shallower, and in older people whose lenses are much larger. The resultant increase in intraocular pressure can cause the eye to become red and painful, and the patient may also feel nauseous.
Signs of angle-closure glaucoma include an eye that is tender, a semi- dilated pupil that is fixed to light and in some cases the cornea can become hazy as a result of stromal oedema. Acute glaucoma is three times more likely to occur in women, than it is in men.
Acute glaucoma is a medical emergency and immediate treatment is required in order to prevent damage to the optic nerve and to reduce the chances of suffering permanent loss of sight in the affected eye. Usually, this condition requires surgery to fully correct, however can be treated with acetazolamide 500 mg intravenously to reduce aqueous flow. Similarly, an infusion of mannitol, to produce
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