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The pathogenesis of glaucomatic illnesses is poorly understood. An increase in ocular pressure can be caused by an increase in the secretion of aqueous humour or a reduction in its outflow. In the elderly, outflow is reduced while at the same time less aqueous humour is produced. This balance is easily disturbed, so that age represents a risk factor for glaucoma in addition to increased ocular pressure. Therapeutic possibilities involve, on the one hand, reducing the secretion of aqueous humour, for example using, β blockers, carbonic anhydrase inhibitors and clonidine. On the other hand, aqueous humour outflow can also be influenced by drugs. Conventional outflow is increased by the administration of miotics. The uveoscleral outflow can be increased by prostaglandin derivates. Drugs which only influence trabecular outflow are not yet available. Future therapeutic possibilities involve new aspects of the pathophysiology, e.c. the use of growth factors, free radical scavenging enzymes and choroidal blood flow.
Dr. E. Lütjen-Drecoll, Institut fur Anatomie, Lehrstuhl II, Universität Erlangen-Nürnberg, 91054 Erlangen, Germany. anat2.gl@anatomie2.med.uni-erlangen.de
3.9 Pathophysiology (Part of: 3 Laboratory methods)
11.1 General management, indication (Part of: 11 Medical treatment)