New insights in the pathogenesis and treatment of normal tension glaucoma

Curr Opin Pharmacol. 2013 Feb;13(1):43-9. doi: 10.1016/j.coph.2012.10.001. Epub 2012 Oct 22.


Increased intraocular pressure (IOP) is a major risk factor for glaucomatous damage and reducing IOP improves prognosis. Nevertheless, there is little doubt that other risk factors besides IOP such as unstable ocular perfusion are involved. Blood flow is unstable if either the IOP fluctuates at a high level (or blood pressure fluctuates at a low level) or if the autoregulation of blood flow disturbed. A common cause for a disturbed OBF autoregulation is a primary vascular dysregulation (PVD) frequently observed in normal tension glaucoma patients. An unstable blood flow leads to recurrent mild reperfusion injury (chronic oxidative stress) affecting particularly the mitochondria of the optic nerve head. OBF regulation can be improved by magnesium, calcium channel blockers as well as with carbonic anhydrase inhibitors.

Publication types

  • Review

MeSH terms

  • Blood Pressure
  • Eye / blood supply
  • Glaucoma / drug therapy
  • Glaucoma / etiology*
  • Glaucoma / physiopathology
  • Humans
  • Intraocular Pressure
  • Optic Nerve Diseases / drug therapy
  • Optic Nerve Diseases / etiology*
  • Optic Nerve Diseases / physiopathology
  • Oxidative Stress
  • Regional Blood Flow
  • Retinal Vein / physiology
  • Risk Factors