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September 2010

September 2010

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ISSN 1391-0736
 The Sri Lanka
Prescriber
 The Sri Lanka Prescriber
is sponsored bythe State Pharmaceuticals Corporation of Sri Lankaas a service to the medical profession
.
September 2010; Volume 18, No. 3Management of glaucoma1Management of rickettsial infections (typhus fever)4Management of common cardiac problems in children7Mouthwashes10Current information about drug registration14
CONTENTS
 
 The Sri Lanka
Prescriber
Editors
Professor Anoja Fernando
 
MBBS, FRCP, BA
Professor Gita Fernando
 
MBBS, FRCP, FCCP
Professor Colvin Goonaratna
 
MBBS, FRCP, FRCPE, FCCP, PhD, DSc
Editorial Board
Chinta Abayawardana
 
Diploma in Pharmacy
Dr Anuja Abayadeera
MBBS, FRCA, MD
Dr Nanda Amarasekara
 
MBBS, MD, FRCP, FCCP, FRACP
Dr Shamya de Silva
 
MBBS, DCH, MD
Dr Ranjan Dias
MBBS, MS, FRCS
Dr Priyadarshani Galappatthy
 
MBBS, MD, MRCP, DMT
Dr Chamari Weeraratne
 
MBBS, MD
Professor Laal Jayakody
 
MBBS, MRCP, PhD
Dr A M O Peiris
 
BDS, FDSRCPS, FFDRCS
Dr Hemamali Perera
 
MBBS, MRCPsych, MD
Professor Harshalal Seneviratne
 
MBBS, FRCOG, DM
Professor Anura Weerasinghe
 
MBBS, MD, FRCP, DCH, DTM&H, PhD, FCCP
Copies of the
Sri Lanka Prescriber
and inquiries from M. P. Kuruppu,Deputy General Manager, Marketing, and Ms Sujathi Jayaratne,Promotional Manager (Telephone 2421833), State PharmaceuticalsCorporation, P. O. Box 1757, 75, Sir Baron Jayathilake Mawatha,Colombo 1.Price per copy Rs 50.00 (students Rs 25.00). Personal callers mayalso obtain copies from the Departments of Pharmacology atthe Medical Faculties in Colombo, Galle and Sri Jayewardenepura.
Published by
Department of PharmacologyFaculty of Medicine271, Kynsey Road, Colombo 8, Sri Lanka. Telephone: +94 11 2695300 Ext 315E-mail: phrm_cmb@hotmail.com
and
State Pharmaceuticals Corporation75, Sir Baron Jayathilake Mawatha, Colombo 1. Telephones +94 11 2320356-9Fax: +94 11 447118E-mail: prmanager@spc.lk Web site: www.spc.lk
Printed by
Ananda Press82/5, Sri Ratnajothi Saravanamuttu Mawatha,Colombo 13. Telephone: +94 11 2435975E-mail: anpress@sltnet.lk
(
Secretary to Board and member
)
Cover picture
America’s first Apothecary General
(1775-1783)
First American Apothecary General was Bostonian AndrewCraigie, commissioned in 1777. Previously he servedMassachusetts’ Committee of Safety as Apothecary; tookpart in the Battle of Bunker Hill. He served Americathroughout the War of Independence.
One of a series:
A History of Pharmacy in Pictures,
presented by Parke, Davis& Company.George A. Bender, Director ©1954 Robert A. Thom, Artist
 
1
Sri Lanka Prescriber, Vol. 18, No. 3, 2010
Introduction
Glaucoma is a disease which causes characteristic opticneuropathy and a progressive visual field loss. It is apotentially blinding condition which can lead to apermanent visual disability. The most important riskfactor is the raised intraocular pressure (IOP)secondary to reduced aqueous outflow through thefiltration angle.
Classification
Glaucoma may be congenital or acquired. Glaucomacan be further subclassified into angle closure typeand open angle type based on the mechanism by whichaqueous outflow is impaired. Glaucoma may also beprimary or secondary depending on the presence orabsence of the associated factors (uveitis, steroidtreatment, pseudoexfoliation) contributing to thepressure rise.
Clinical features
Symptoms and signs depend on the type of glaucoma.
Primary open angle glaucoma (POAG)
POAG is the most prevalent type, affecting approxi-mately 1 in 100 of the general population over the ageof 40 years. It is generally bilateral but not alwayssymmetrical. It is an adult onset asymptomatic diseasecharacterised by elevated intraocular pressures of >21 mmHg, open normal angle on gonioscopy,glaucomatous optic nerve damage, and visual field loss.
Angle closure glaucoma
In classical cases of acute angle closure glaucomathere is a rapidly progressive unilateral visual lossassociated with periocular pain, redness, and nauseaand vomiting. It commonly affects south east Asianwomen around the age of 60 years. Slit lampexamination shows severely elevated IOP (50 - 100mmHg), ciliary flush, shallow anterior chamber withperipheral iridocorneal contact, corneal oedema,aqueous flare, and a fixed semi-dilated pupil.
Management of glaucoma
Intermittent angle closure occurs in predisposed eyesand the diagnosis is based on the characteristic historyof recurrent attacks of transient blurring of vision withhaloes around the lights, ocular discomfort and frontalheadache.
Normal tension glaucoma
It is an asymptomatic disease characterised by a meanIOP of <21 mmHg with glaucomatous optic nervedamage and visual field loss. Gonioscopy shows opendrainage angle with absence of secondary causes forglaucomatous optic nerve damage.
Panel 1. Risk factors and associations for primaryopen angle glaucoma
Age – most cases present after the age of 60 years
Race – common in blacks
Family history – frequently inherited and a risk tosiblings of 10% and to offspring of 4% has beensuggested.
Myopia
Diabetes mellitus
Reduction of perfusion pressure – visual fieldprogression may occur despite a well controlled IOPif there is a nocturnal dip in blood pressure
Panel 2. Features of glaucomatous optic nervedamage
Increased vertical cup disc ratio
Notching of the neuroretinal rim
Peripapillary atrophy
Retinal nerve fibre dropouts
Bearing of circumlinear blood vessels
Disc margin haemorrhages

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