|Year : 1965 | Volume
| Issue : 4 | Page : 144-147
Oral glycerol in treatment of glaucoma
OP Ahuja, PPD Purkayastha
Aligarh Muslim University Institute of Ophthalmology and Gandhi Eye Hospital, Aligarh (U.P.), India
|Date of Web Publication||25-Feb-2008|
O P Ahuja
Aligarh Muslim University Institute of Ophthalmology and Gandhi Eye Hospital, Aligarh (U.P.)
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Ahuja O P, Purkayastha P. Oral glycerol in treatment of glaucoma. Indian J Ophthalmol 1965;13:144-7
Osmotic agents have been employed for more than 2 decades to lower both the intracranial and intraocular pressures, chief among which are urea [Javid and Settlage (1956). Crews and Davidson (1961) Trevor-Roper- (1963)] and Mannitol (Weiss, Schaffer & Wise (1962), Smith & Drance (1962) which have been employed by the intravenous route. Although effective, these agents are not considered ideal because of their direct loading into the systemic circulation. By the oral route, administration of Glycerol has been employed to reduce intraocular pressure in cases of glaucoma.
In the present investigation the effect of Oral Glycerol was studied in 43 eyes suffering from glaucoma of various types.
| Material and Methods|| |
The study was carried out in uncontrolled glaucoma patients collected from the indoor section of Gandhi Eye Hospital Aligarh.
Ocular tension was recorded by a Schiotz tonometer (Calibration - 1955 tables) and then glycerol (1 cc/kgm of body weight) with an equal amount of water was given orally to these patients. To improve the taste half a lemon was squeezed into the mixture of glycerol and water. Following administration of this mixture ocular tension was recorded every 10 minutes for 30 minutes and then every half hourly for 2 hours, followed by recording after 3 hours. A final reading was taken after 24 hours. All tonometric readings were taken with the same tonometre by the same observer.
While glycerol administration caused a marked fall of tension in all cases, the overall response was broadly guided by the type of glaucoma treated.
Chronic simple Glaucoma
(see [Table - 1])
Tension started falling within 10 minutes of glycerol administration in a large number of eyes, and within 30 minutes in most eyes. Lowest limit was reached within one hour after which tension started increasing again. After 24 hours tonometric readings were near the pre-glycerol level.
Acute congestive (angle closure) glaucoma:
(see [Table - 2])
Most dramatic results were obtained in this group of patients. There was a marked reduction in ocular tension from very high to near normal figures, accompanied by considerable subjective improvement. It was further observed that in 3 out of 4 patients of primary angle closure the initial effect on tension was maintained and tension remained normal when seen after 24 hours and subsequently. As for the rest, patients of secondary angle closure due to intumescent cataract, ocular tension when recorded after 24 hours was found to be near the pre-glycerol level.
Chronic congestive glaucoma:
(see [Table - 3])
Eyes in this group behaved similar to the eyes of chronic simple glaucoma except that the initial effect was more marked in most of the eyes. Tension after 24 hours reached the pre-glycerol level.
Absolute glaucoma: (see [Table - 4])
The effect of glycerol on ocular tension was least marked in this group of cases. Though all the eyes showed a fall in tension, the extent of fall was less as compared to the eyes of other groups.
| Discussion|| |
Although glycerol in this investigation was found to be consistently effective, the effect lasted only temporarily except in cases of primary angle closure. It is felt therefore that the drug is of a limited use in most of the cases. It can be profitably employed to reduce the tension before operation in glaucomatous- eyes undergoing surgery under -local anaesthesia. Administration of this drug about half an hour before operation may prove of much value for safety during surgery. Frequent doses of glycerin in a day for a long period would be required to control the tension in cases not undergoing surgical treatment. That, however, does not seem to be a practical proposition.
The drug appears to be of great value in cases of angle closure glaucoma of the primary type. In these cases it does not only reduce the tension but may also lead to a readjustment in the intraocular volume and pressure in posterior and anterior chambers in such a manner that the angle closure is relieved and normal aqueous humour dynamics are re-established. The initial fall of tension is therefore maintained because of the establishment of normal circulation of aqueous humour. This phenomenon was observed in 3 of our 4 cases of this type. In these patients, a peripheral iridectomy was performed to avoid a fresh attack of angle closure. None of these cases were seen to have a high tension in the follow up period. Such an opening of the angle could not be achieved in cases of secondary angle closure because of the faqt that the block was due to the mechanical pushing of iris root by the swollen lens.
Intravenous infusion of urea although effective in lowering intraocular pressure, has been found to produce certain side effects. Grollman & Grollman (1959) reported anorexia, nausea and vomiting while Bering and Aveman (1960) found electrocardiographic changes following administration of the drug. Local thrombosis of the vein of entry (Davis, Duehr and Javid (1961) and in case of accidental leakage of urea, local tissue necrosis has been observed (Watkins, Stubbs and Levin - 1961). Mannitol also, was considered by Virno, Cantore, Bietti and Bucci (1963) to cause side effects common to osmotically acting drugs.
Contrary to the above reports glycerol has been reported to be free from these side effects and is well tolerated by patients. As long back as 1933, Johnson, Carlson and Johnson found glycerin to be free from ill effects when administered in 14 human subjects in dosage of 30 cc. three times a day for 50 days. Solviter (1958) observed that intravenous administration of 50 gram of glycerin in 1000 cc. of 5% glucose in 16 patients did not cause any side effect. In our series of cases also, no ill effects of the drug were observed except a mild headache in 7 patients which improved on lying down. One patient complained of increased diuresis as well. In view of these factors,- glycerol is ' a safe and at the same time effective drug to use as compared to other osmotic agents employed. None of the patients complained of the unpalatable nature of the mixture.
Summary and Conclusions:
- Effect of Oral administration of glycerol was studied in 43 eyes suffering from various types of glaucoma.
- Glycerol caused a marked fall of tension in all eyes - the effect lasting only temporarily. It is therefore suggested that the drug is of limited use and can best be employed pre-operatively for glaucomatous eyes undergoing surgery.
- The drug was found to be of best value in cases of angle closure glaucoma (primary type) where not only the tension was redubed but also the angle closure was relieved and normal outflow of aqueous restablished.
- The drug did not cause any side effect except a mild headache in seven patients and increased diuresis in one.
We are grateful to Prof. B. R. Shukla for his advice provided in this investigation.
| References|| |
Crews, S. J. & Davidson, S. I. (1961): Brit. J. Ophth. 45, 769.
David, M.D., Duehr, P. A. & Javid, M. (1961): A.M.A. Arch. Ophth. 65, 525.
Grollman, E. F. & Grollman, A. (1959): J. Clin. Invest. 38, 749.
Javid, M. S. Settlage, P. (1956): J. A.M.A. 160, 943.
Johnson, V.; Charlson, A. J. & Johnson, A. (1933): Ans. J. Physiol. 103, 517.
Smith, E. W. and Drance, S. M. (1962): A.M.A. Arch. Ophth. 68, 734.
Solviter, H. A. (1958): J. Clin. Invest. 37, 619.
Trevor-Roper, P. D. (1963): B. C. Royal Soc. Med. 57, 37.
Virno, M., Cantore, P.; Bietti, C. and Bucci, M. G. (1963): Am. J. Ophth. 55, 1133.
Weiss, D. I., Schaffer, R. N. and Wise, B. L. (1962): A. M. A. Arch. Ophth. 68, 734.
[Table - 1], [Table - 2], [Table - 3], [Table - 4]