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Glaucoma — pharmacological treatment

by Andrew Husband and Alan Worsley

There is more to glaucoma than a raised intraocular pressure (IOP). However,IOP remains the only factor in the disease that can currently
be manipulated.

IOP is physiologically regulated by balancing the production and outflow of
aqueous humour. In order to produce aqueous humour, plasma moves from the ciliary vasculature to the posterior chamber through the stroma (which mainly consists of connective tissue) and the pigmented and non-pigmented cells of the ciliary epithelium.

This movement of plasma is based on the three processes of diffusion, ultrafiltration and active transport. Loss of aqueous humour occurs by two distinct pathways:

  • Drainage through the trabecular meshwork (a sponge-like, porous
    network) and canal of Schlemm, ultimately to the episcleral vein and into
    the systemic circulation
  • Drainage through uveoscleral tissue (ie, through the ciliary muscle into the suprachoroidal space)

Drugs used to treat glaucoma therefore broadly work in one of two ways: either to reduce the production or to increase the drainage (ie, loss) of aqueous humour.

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Citation: Hospital PharmacistURI: 11045046

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