A 55yo man presents with mild headache. He has changed his spectacles thrice in 1 yr. there is
mild cupping present in the disc and sickle shaped scotoma present in both eyes. What is the
single most appropriate tx?
a. Pan retinal photo coagulation
b. Pilocarpine eye drops
c. Corticosteroids
d. Scleral buckling
e. Analgesics alone
answer: B
Open angle glaucoma with cupping of the disk and scotoma due to loss of peripheral vision.
Treatment : decrease IOP by decreasing aqueous
increase aqueous outflow
topical cholinergics e.g. pilocarpine
topical prostaglandin analogues e.g. bimatoprost
topical α-adrenergics e.g. epinephrine
decrease aqueous production
topical β-blockers
topical and oral carbonic anhydrase inhibitor e.g. acetazolamide
topical α-adrenergics
• laser trabeculoplasty, cyclophotocoagulation in order to achieve selective destruction of ciliary
body (for refractory cases)
• trabeculectomy
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