Glaucoma Diagnosis and Management Flashcards

Why is brimonidine contraindicated in infants and children under 2 years old?

Answer: It crosses the blood-brain barrier and can cause CNS depression, hypotension, and apnea

Brimonidine's lipophilicity allows CNS penetration in infants, risking somnolence, bradycardia, and apnea.

What is the main mechanism of IOP lowering by prostaglandin F2α analogs such as latanoprost?

Answer: Higher uveoscleral outflow through ciliary muscle extracellular matrix remodeling

PGAs upregulate matrix metalloproteinases in the ciliary muscle, which increases uveoscleral outflow.

Which adverse effects are most characteristic of netarsudil, a Rho kinase inhibitor?

Answer: Conjunctival hyperemia and corneal verticillata

Netarsudil commonly causes conjunctival hyperemia, subconjunctival hemorrhages, and whorl-like corneal verticillata.

Which systemic condition is the strongest contraindication to topical nonselective timolol?

Answer: Asthma or second-degree heart block

Nonselective β-blockade can cause bronchospasm and worsen bradyarrhythmias or AV block.

A patient on long-term oral acetazolamide reports flank pain and hematuria. Which side effect explains this?

Answer: Calcium phosphate nephrolithiasis

Carbonic anhydrase inhibitors cause metabolic acidosis and low urinary citrate, which predisposes to calcium stones.

Latanoprostene bunod differs from latanoprost by releasing which additional active moiety?

Answer: Nitric oxide

Latanoprostene bunod releases nitric oxide, which relaxes the trabecular meshwork and increases conventional outflow.

After trabeculectomy in a hyperopic eye, the anterior chamber is uniformly flat, the IOP is high, the iridotomy is patent, and no choroidals are seen. Which medication should be avoided?

Answer: Pilocarpine

In aqueous misdirection, miotics move the lens-iris diaphragm forward and make it worse; cycloplegics are the mainstay.