A 55 y/o African American man with hypertension and diabetes presents to the ophtalmologist clinic for routine examination. The patient has no visual complaints. Visual acuity is 20/20 in both eyes. Funduscopic examination reveals enlarged optic nerve head cupping with significant rim pallor in both eyes. Gonioscopy reveals open angles, and aplanation tonometry reveals borderline intraocular pressures. Which of the following could be used to treat this patient?
A. Corticosteroids
B. Intravenous Mannitol
C. Isoproterenol
D. Phenoxybenzamine
E. Pilocarpine
E although not the first choice is the best answer. The patient has open angle glaucoma and no symptoms and IV treatment is not indicated. Treatment of choice are beta blcokers and prostaglandins
The correct answer is E. This patient has open angle glaucoma. (OAG) . This condition is dx by increased intraoccular pressure, abnormal optic disk findings and typical field loss. The eye is not red or painful, the pupil and cornea appear normal and it commonly affects both eyes. OAG can be treated with a variety of meds. Pilocarpine is a muscarinic agonist that produces rapid miosis and contraction of the ciliary muscles. This can be used in the acute treatment of OAG or closed angle glaucoma to open the trabecular meshwork around Schlemm's canal increasing drainage of humor and decreasing intraocular pressure.
OAG can also be treated with agents that decrease secretion like beta-blockers (timolol), carbonic anhydrase inhibitor, and alpha 2 agonist (brimonidine).
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