Question

Most ideal drug in open angle glaucoma with myopia is

• A. 2% pilocarpine
• B. 10% phenylephrine
• C. 0.5% Timolol
• D. Atropine

Hint:

Think about which class of glaucoma drug does not cause pupillary constriction.

Answer 1

The Correct Option is C

Step 1: Understanding the Question:
The question asks for the best drug to lower intraocular pressure in a patient who has both open angle glaucoma and myopia, a combination where the choice of agent matters because of a specific retinal risk in myopic eyes.

Step 2: Key Concept or Approach:
Myopic eyes have an elongated globe with a thinner, more atrophic peripheral retina, making them more prone to retinal breaks and detachment. Miotic drugs, which constrict the pupil and pull on the peripheral retina through zonular traction, further raise this risk, so they are best avoided in myopic glaucoma patients. A drug that lowers intraocular pressure without causing miosis is preferred.

Step 3: Working Through the Options:
Pilocarpine is a miotic that increases the risk of retinal detachment in a myopic eye and is best avoided here. Phenylephrine is a mydriatic used diagnostically or to treat hypotension; it is not a standard glaucoma medication and does not lower intraocular pressure in a controlled, sustained way. Timolol, a non-selective beta-blocker, reduces intraocular pressure by decreasing aqueous humour production and does not affect pupil size, so it carries no added retinal detachment risk, making it the most suitable choice in a myopic glaucoma patient. Atropine is a mydriatic and cycloplegic that would raise, not lower, intraocular pressure risk in susceptible eyes and has no role in glaucoma treatment.

Step 4: Conclusion:
0.5% Timolol is the most ideal drug for open angle glaucoma in a patient with myopia.