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Ophthalmology · Glaucoma: uveitic glaucoma and drug choice
Sample itemA patient with active HLA-B27 anterior uveitis has an intraocular pressure of 34 mmHg and early posterior synechiae. Which antiglaucoma drug is best avoided?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
A. Pilocarpine
In uveitic glaucoma aqueous suppressants are preferred. Miotics such as pilocarpine increase posterior synechiae by keeping the pupil small and break down the blood-aqueous barrier further, and prostaglandin analogues are also used cautiously because they may aggravate inflammation.
Option by option
A. Pilocarpine (correct)
Correct. Pilocarpine constricts the pupil, promotes synechiae and worsens inflammation.
B. Dorzolamide
Dorzolamide is a topical carbonic anhydrase inhibitor that suppresses aqueous and is appropriate.
C. Timolol
Timolol lowers aqueous production and does not promote synechiae.
D. Brimonidine
Brimonidine lowers aqueous production and increases uveoscleral outflow and can be used.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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