|Year : 1981 | Volume
| Issue : 3 | Page : 229-233
Treatment of glaucoma with atenolol eye drops
SP Dhir1, PL Sharma2, IS Jain1
1 Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
S P Dhir
Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Dhir S P, Sharma P L, Jain I S. Treatment of glaucoma with atenolol eye drops. Indian J Ophthalmol 1981;29:229-33
Atenolol (Tenormin, ICI 66082) is a newer selective beta-I adrenoceptor blocker. It has been shown to be devoid of membrane stabilising effects,. It also lacks intrinsic sympathomimetic properties. Oral administration of atenolol has been shown to reduce intraocular pressure (IOP),,,. Eye drop containing atenolol have been also shown to reduce IOP in patients with ocular hypertension after a short duration therapy,.
We undertook a study of 4% atenolol eye drops in the management of IOP in glaucoma patients over a prolonged period.
| Materials and methods|| |
Twenty five patients attending the glaucoma clinic of eye out patients department of the Postgraduate Institute of Medical Education and Research, Chandigarh were treated with 4% atenolol eye drops, three times a day, for periods varying from 7 days to six months. The drug was discontinued in case of inadequate response of development of side effects. Four patients did not come for follow up after enterance in the study, thus bata on 21 cases is presented.
The eye drops were supplied by Imperial Chemical Industries Pharmaceuticals (London) containing 4% atenolol and 0.02% of v/v of benzalkonium chloride as a preservative. The eye drops are adjusted to a pH of 6.0.
| Observations|| |
Chronic simple glaucoma:
Fourteen eyes of 9 patients with chronic simple glaucoma were treated with atenolol eye drops [Table - 1]. Six eyes of 4 patients received treatment for over 6 months with good control of IOP. One eye of one patient and both eyes of one patient received treatment for four months. Thus six of the nine patients responded favourably over prolonged administration. One patient used the drops for one week only with good response and left town. Another patient had a good control of IOP but found it intolerable due to giddiness and. mental clouding. Patient No. 9 had a paradoxical rise of IOP. He was switched to pilocarpine and was adequately controlled.
Nine eyes of 5 patients with juvenile glaucoma were treated with atenolol eye drops [Table - 2]. Five eyes of 3 patients received treatment for over 6 months with adequate control of 10P. One patient with angle cleavage syndrome responded poorly and was operated for filtering surgery. Another patient with pigmentary glaucoma also did not respond favourably. He was switched to pilocarpine eye drops.
Angle Closure Glaucoma
Four cases of failed surgery in angle closure glaucoma with occluded angles and one case with chronic angle closure glaucoma were treated with local atenolol eye drops [Table - 3]. None of the patients responded with adequate control of lOP.
Two patients with aphakic glaucoma were studied [Table - 3]. Both cases had vitreous in the anterior chamber and did not respond satisfactorily to atenolol eye drops.
| Discussion|| |
Chronic Simple Glaucoma : Topical instillation of 4% atenolol three times a day could adequately lower lOP in patients with chronic simple glaucoma. A lowering of lOP by topical application over short duration of treatment with atenolol has been previously reported,, The present study shows that this beneficial effect can be maintained over a prolonged period (six months). Previous studies have shown that peak effect is reached after two to three hours of instillation of drops and the effect is demonstrable even after 8 hours. In the present study, 8 hourly instillation of drops was practised. Though no diurnal variations of IOP were recorded on these patients but majority of patients had over 12 tonometric reading over a period of six months and no significant variations in IOP were noted.
Out of nine patients, eight responded favourably whereas one developed a paradoxical rise of IOP. Six patients successfully continued treatment for over four months and of these four patients for over six months. Thus prolonged control of lOP with this medication is feasible.
Juvenile Glaucoma : Three patients were adequately controlled with 4% atenolol over a six months period out of five cases of juvenile glaucoma. Two of those controlled were cases of early onset of chronic simple glaucoma and one case was operated arrested bupthlamos. Two cases of failure were cases of angle cleavage syndrome and pigmentary glaucoma. No report is available in the literature on use of beta blockers in Juvenile glaucoma. Essentially the three controlled patients behaved like chronic simple glaucoma patients.
Angle Closure Glaucoma and Aphakic Glaucoma : The poor response in angle closure glaucoma is possibly due to obliteration of the angle of the anterior chamber in these patients. It is well known that after filteration surgery the angle is obliterated and non-functioning. Similar situation existed in the two aphakic glaucoma patients who had vitreous blocking the angle of the anterior chamber, both cases were failures. It is quite evident from this study that local atenolol drops lower intraocular pressure only in patients having open angles. Thus the mechanism of lowering of intra-ocular pressure must lie in the trabecular mesh work. It might be lowering the resistance to outflow and thus lowering the intra-ocular pressure.
During the study period two side effects were noticed. One patient reported giddiness and mental cloudiness and another developed allergic reaction of the conjunctiva and lids. An additional patient had paradoxical rise of IOP. Seven patients received treatment for six months without any systemic or local side effects. No dryness of the conjunctivae or corneas were noticed. Local atenolol eye drops offer considerable advantages over miotics.
There is no demonstrable effect on the pupillary size or accommodation. Majority of patients of chronic simple glaucoma in old age group have lenticular opacities and find diminution of vision after use of miotics. All the patients who were successfully controlled with atenolol eye drops were very reluctant to switch back to miotic therapy. Even younger patients preferred atenolol eye drops to miotics for reasons of accommodation problems with miotics.
| Summary|| |
Twenty five patients of glaucoma were treated with 4% atenolol eye drops three times a day. The drug was found to control intraocular pressure in 8 out of 9 patients with chronic simple glaucoma and in 3 out of 5 patients of juvenile glaucoma. Seven patients received treatment for six months without any ill effects. The drug was found to be ineffective in angle closure glaucoma. It appears that the drug acts by lowering the resistance in the trabecular meshwork.
| References|| |
Barret, A.M., Carter, J. Fitzerald, J. D. Hull, R and Le Count D., 1973., Brit. J. Pharmacol, 48 ; 340.
Dhir S. P., Sharma P.L., Chopra M.L. and Jain LS., : 1977, Proc. All India Opthalmol. Soc. p : 140.
Elliot, M.J.. Cullen, P.M., and Phillips, C.I., 1975 Brit. J. Ophthalmol. 59 : 296.
Macdonald, M.J., Gore, S.M., Cullen. P.N. and Phillips, C.I., 1977, Brit. J. Ophthalmol. 61 : 349.
Phillips, C.I., Gore, S.M., Macdonal, M., and Cullen, P.m., 1977, Brit. J. Ophthalmol. 61 : 349.
Wettrell, K., and Pandolfi, M., 1975, Brit. J. Ophthalmol. 21 :451.
Wettrell, K. and Pandolfi, M., 1977. Brit. J. Ophthalmol. 61.: 334.
[Table - 1], [Table - 2], [Table - 3], [Table - 4]