Punctal occlusion means closing off the tear duct so the medicine does not travel down the duct to the nasal cavity and then enter the systemic symptom where medications like Timolol (~olol =Beta Blocker) can affect the heart.


  They call Blood Pressure “The Silent Killer” because there are not symptoms and people don’t feel sick (and therefore don’t feel like they need to take their medication for it.)  Glaucoma should be called high eyeball pressure and be known as the silent blinder.  Like Blood Pressure there are usually no symptoms, until pressure gets really high.  So people don’t feel it’s important to take their meds. Pt. teaching would be important here.


  Miotic Drug – causes pupil constriction,    Miosis – pupil constriction, gets smaller,   Mitosis – Cell division, not glaucoma related


 Medication  Mechanism of action  Side Effects  Nursing Implications
 Cholinergics (miotics)(pilocarpine**, carbachol) Increases aqueous fluid outflow by contracting the ciliary muscle and causing miosis. Reduces production of aqueous humor and increases outflow Pain around eye, blurry vision and difficulty seeing in dark. Difficulty seeing in low light
 Beta-Blockers (betaxolol, timolol**  Decreases aqueous humor production  Can have systemic effects including bradycardia, hypotension and exacerbation of pulmonary disease Teach punctal occlusion. Usually not given to patients with asthma, COPD, bradycardia, or  2º heart block.
 ** Seen on NCLEX or common in review books.
Med information from: Brunner & Suddarth’s Textbook of Medical-surgical Nursing, Volume 1 Suzanne C. O’Connell Smeltzer, Brenda G. Bare, Janice L. Hinkle, Kerry H. Cheever Lippincott Williams & Wilkins, 2010

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