2020–2021 BCSC Basic and Clinical Science Course™
Chapter 12: Medical Management of Glaucoma and Ocular Hypertension
General Approach to Medical Treatment
Therapy for Acute Intraocular Pressure Elevation
The goals of medical treatment of acute IOP elevation are to prevent further damage to the optic nerve; to clear corneal edema, if present; and to reduce intraocular inflammation. Hyperosmotic agents and systemic CAIs may be required in order to lower IOP in eyes with severe IOP elevation in preparation for definitive treatment. When the IOP is severely elevated, ischemia of the pupillary constrictor muscle can interfere with the miotic action of pilocarpine and other parasympathomimetic agents. Therefore, in patients with acute primary angle closure, lowering the IOP also allows pupillary constriction before an iridotomy is performed (see Chapter 9). Severely elevated IOP may cause collapse of Schlemm canal and closure of the collector channels; reduction of IOP may help restore conventional outflow.
Table 12-3 Preservative-Free and Alternatively Preserved Ocular Hypotensive Agents
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.