By Pharmacist Salwan Salem

* Is the organ which gives the sense of sight. * Eye allows us to see and interpret the shapes, colors, and dimensions of objects by processing the light they reflect or emit. * The eye able to detect bright light or dim light, but cannot sense objects when light is absent.

* The eye consists of a retinal –lined fibrovascular sphere which contains the aqeous humor, the lens and viterous body. * Retina Serves the primary purpose of photoreception -Role of other structures : act on focus image on retina, to regulate amount of light entering the eye, or to provide nutrition,protection,or motion.

1-Sclera : is white and opaque material, for protection 2- Cornea: white and transparent, for protection 3- Retina : The sensory retina covers the inner posterior two thirds of the wall of the globe.

* It consists of several layers : Retina composed of 10 layers, from outside (nearest the blood vessel enriched chharoid ) To the inside ( nearest the gelatinous viterous humor) The rods and cones, the light receptive elements of the retina,transform physical energy into nerve impulses.

4-Lens Is a biconvex, transparent, and avascular structure. It is suspended behind the iris by the a suspensory ligament, which connects it with the ciliary body 5 -The aqeous humor : is transparent,gelatinous fluid secreted from the ciliary epithelium, it is located in the anterior and posterior chambers of eye.

* Is deisease of the eye in which fluid pressure withen the eye rises. * IOP is the pressure caused by the fluid inside the eye that help maintain the shape of eye. * Normal IOP mmHg * May lead to lose vision * Affect both eyes * Aqous humor builds up,and increase pressure withen the eye

* 1- Open angle glaucoma: * The most common type of G ( 90% ) * Caused by : slow clogging of drainage canals, increased IOP * Open angle means the angle where the iris meets the cornea is a wide and opened as it should be.

2-Closed angle glaucoma : Caused by blocked drainage canals, sudden rise in IOP Which has closed angle between iris and cornea 3- Normal tension G 4-conginetal G

* Loss of periphral vision * Sensitivity to light and glare * Problems with night vision * Blurred vision

* Increased IOP * Age >60 yr * Race : African-American * Family history * Medical conditions: DM (3 times risk), HT * Eye injury * CTS chronic use may develop secondary G.

* Blind spots in peripheral vision * Tunnel vision * Total blindness

* Tonometry : to measure eye ball pressure, High IOP suggest Glaucoma * Optic nerve examination : check damage * Visual field exam : pt visual field ( area in front) will be mapped to check for visual loss

* There is no cure of Glaucoma, and if the optic nerve damaged,it cannot be fixed * The progression of G can be controlled by 1- lowering IOP, 2-increase drainage of aqeous humor (out flow) by prostoglandins, 3- decrease production of Aqeous humor by B- Blockers, Carbonic anhydrase inhibitors.

4-Surgery to improve outflow of Aq.Humor: Laser Surgery by trabeculoplasty, Filtering surgery by trabeculectomy. 5-Drainage implants : by inserting tube in eye to facilitate draining of Aq.humor to reduce Pressure

* Treat open angle G * By increasing outflow of Aq.Humor * Ex: Latanoprost ( Xalatan) * Travoprost (Travatan) * S/E: mild reddening of eye, eyelid pigmentation, blurred vision

* Reduce the production of IOP, by block the action of Symp. N.S, which leads to decrease IOP, the presice mechanism is uknown * Beta blocker * Ex: Timolol ( Timoptic) * Betaxalol ( Betoptic) * s/E: difficulty breathing, Bradycardia, decrease B.P, impotence.

* Reduce production of Aq.Humor and increase out flow. * Alpha 2 receptor agonist : Ex: Brimonidine ( Alphagan) Apraclonidine ( Lopidine ) * S/E : irrigular H.R, high blood pressure, fatigue, swollen eyes, dry mouth.

-Systemic adminstration (oral) Ex: Acetazolamide -Carbonic anhydrase is enzyme present in biochemical of aqueous humor. So it decrease Aq.humor production. * Ex: Dorzolamide (Trusopt) eye drops * Brinzolamide ( Azopt) eye drop s -S/E : frequent urination

* Which increase out flow of Aq.Humor withen eyes. * Muscarinic receptor agonist * Ex: Pilocarpine (Isopto carpine) * S/E: Smaller pupils, Blurred vision.

* Treatments for Glaucoma * Agents enhancing aqueous humor outflow Muscarinic agonists (pilocarpine) Prostaglandins (Latanaprost) * Agents suppressing aqueous humor production ß adrenergic antagonists (Timolol)  2 adrenergic agonists (Aproclonidine) Carbonic anhydrase inhibitors (Acetazolamide)