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ARTICLE
Year : 1965  |  Volume : 13  |  Issue : 4  |  Page : 144-147

Oral glycerol in treatment of glaucoma


Aligarh Muslim University Institute of Ophthalmology and Gandhi Eye Hospital, Aligarh (U.P.), India

Date of Web Publication25-Feb-2008

Correspondence Address:
O P Ahuja
Aligarh Muslim University Institute of Ophthalmology and Gandhi Eye Hospital, Aligarh (U.P.)
India
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Ahuja O P, Purkayastha P. Oral glycerol in treatment of glaucoma. Indian J Ophthalmol 1965;13:144-7

How to cite this URL:
Ahuja O P, Purkayastha P. Oral glycerol in treatment of glaucoma. Indian J Ophthalmol [serial online] 1965 [cited 2020 Nov 24];13:144-7. Available from: https://www.ijo.in/text.asp?1965/13/4/144/39259

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Table 1

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Table 1

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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 Top


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.

Results:

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 Top


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.[10]

Summary and Conclusions:

  1. Effect of Oral administration of glycerol was studied in 43 eyes suf­fering from various types of glau­coma.
  2. 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.
  3. 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.
  4. 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 Top

1.
Crews, S. J. & Davidson, S. I. (1961): Brit. J. Ophth. 45, 769.  Back to cited text no. 1
    
2.
David, M.D., Duehr, P. A. & Javid, M. (1961): A.M.A. Arch. Ophth. 65, 525.  Back to cited text no. 2
    
3.
Grollman, E. F. & Grollman, A. (1959): J. Clin. Invest. 38, 749.  Back to cited text no. 3
    
4.
Javid, M. S. Settlage, P. (1956): J. A.M.A. 160, 943.  Back to cited text no. 4
    
5.
Johnson, V.; Charlson, A. J. & John­son, A. (1933): Ans. J. Physiol. 103, 517.  Back to cited text no. 5
    
6.
Smith, E. W. and Drance, S. M. (1962): A.M.A. Arch. Ophth. 68, 734.  Back to cited text no. 6
    
7.
Solviter, H. A. (1958): J. Clin. Invest. 37, 619.  Back to cited text no. 7
    
8.
Trevor-Roper, P. D. (1963): B. C. Royal Soc. Med. 57, 37.  Back to cited text no. 8
    
9.
Virno, M., Cantore, P.; Bietti, C. and Bucci, M. G. (1963): Am. J. Ophth. 55, 1133.  Back to cited text no. 9
    
10.
Weiss, D. I., Schaffer, R. N. and Wise, B. L. (1962): A. M. A. Arch. Ophth. 68, 734.  Back to cited text no. 10
    



 
 
    Tables

  [Table - 1], [Table - 2], [Table - 3], [Table - 4]



 

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