Glaucoma question

[Bears]

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hey all,

just doing some last minute reviewing and this concept has always tripped me up - narrow vs. open angle glaucoma.

please help me understand what is going on. in narrow angle, the angle at the canal of schlemm is closed off and thus preventing the flow of aq. humor. to treat this, you want to open this angle up. of course you want to start initial tx with acetozolamide and a beta blocker. but also you can give carbachol or pilocarpine (muscarinic agonists). im confused as to how this relieves the glaucoma. in some books ive read that these agents work on the pupillary sphincter of the eye (causing miosis and hence opening the angle). other books say these agents work work on the ciliary muscle to open the angle. i know carbachol/pilocarpine work on both the ciliary and sphincter muscle and hence can be used for narrow and open angle glaucoma but im confused as to what mechanism does what. also, how does epi help with open angle glaucoma? is it because of its alpha-1 properties causing mydriasis?

any ideas? thanks! test tomorrow!

 

[Scaredshizzles]

Dear lord, unless you're studying for a class exam in some ultra hard pharm class at some Ivy League or something, don't waste your time on that. The fact that different books say different things about it guarantees that it is not testable, forget the fact that it is waaay too detailed.

In terms of sources though, I trust emedicine over just about any. (I know someone will bring up some example of where it is inaccurate, especially people in the habit of bashing everything---but in my opinion it is as good as it gets, and obviously very easy to find information---just google for the emedicine article, search for the text words you're looking for, etc.) So if your mind won't settle without an answer to that, I'd look there.

 

[Arctic Char]

this might help:

http://images.google.com/imgres?img...ges?q=open+angle+glaucoma&svnum=10&um=1&hl=en

 

[Bears]

thanks! i really hope i dont get a question on this stuff...