Ординатура / Офтальмология / Английские материалы / Clinical Pathways in Glaucoma_Zimmerman, Kooner_2001

Figure 16-12. Management of a patient with glaucoma and neurologic disorders.

Does the Central Nervous System Regulate the IOP?

A central nervous system influence on the regulation of the IOP has been studied extensively. However, the full extent of its regulatory role has not been established. The IOP can be regulated by neural and/or humoral influences on the rate of aqueous humor formation.294,295 The role of the hypothalamus in this regulatory process has been studied extensively.296 A hypothalamic center sensitive to osmotic pressure has been thought to regulate the IOP by efferent optic nerve fibers.297 Their full role still remains unclear.298 In addition to that, injection of oxytocin into the cat hypothalamus raises the IOP.299

The sympathetic nervous system clearly influences aqueous humor dynamics by influencing the diurnal rhythm of aqueous flow.300 Autonomic dysfunction in glaucoma has been postulated.301,302 Centrally acting I1-imidazoline receptor agonists have been shown to lower the IOP.303 In rabbits, the suprachiasmatic nucleus seems to be involved in the diurnal regulation of the IOP.304

In myotonic dystrophy ocular hypotony is quite common.305 It is controversial whether this is due to a central effect through elevated endogenous circulating gonadotropins resulting in elevated cyclic adenosine monophosphate (AMP) and decreased aqueous humor production306 or to locally increased uveoscleral outflow.307

392 Glaucoma Associated with Systemic Disease

Epidemiology and Importance

Is Glaucoma Associated with Any Neurologic Disorders?

Although it seems clear that the central nervous system exerts some influence on the regulation of the IOP, no neurologic disorder per se is known to cause glaucoma by the mechanism of IOP elevation. A significant number of patients with Alzheimer’s disease also have glaucoma. Again, a causal relationship has not been established.308 Diurnal IOP variations seem to be higher in patients with open-angle glaucoma.309

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