Which term describe a stye of the eyelash follicles?

A. Uveitis

B. Chalazion

C. Hordeolum

D. endophthalmitis

C. Hordeolum.

uveitis infection Ciliary body, choroid, and iris. Chalazion infection of meibomian glands. endophthalmitis bacterial or fungal infection of inner eye

Which ocular drug belongs to the category of NSAID's? Select all that apply

A. Ketorolac

B. Diclofenac

C. Natamycin

D. Sulfacetaide

E. Dexamethasone

A. Ketorolac, B. Diclofenac

Natamycin is an anti fungal- binds to sterols in the fungal cell membrane. Sulfacetamide is a sulfonamide that blocks folic acid synthesis. Dexamethasone is a synthetic Corticosteroid. It inhibits the expression of phosopolipases

A patient has a wick in the right ear due to Otis external with significant swelling of the external ear canal. How frequently would the wick be replaced?

A. once per day

B. Three times per day

C. Every 24 to 48 hours

D. Only when saturated

C. Every 24 to 48 hours

The wick should be saturated with medication. It pulls the medication Into the ear.p 590

The patient is complaining of excessive ear wax that dimities hearing ability. Which medication would the nurse anticipate incorporating into the patient's plan of care?

A. Glycerin

B. Hydrocortisone

C. acetic acid

D. Carbamide peroxide

D. Carbamide peroxide

p. 592

Which otic antimicrobial may cause ototoxicity?

A. Corticosteroid

B. Aminoglycoside

C. Cloramphenicol

D. Fluoroquinolone

B. Aminoglycoside

Chloramphenicol is contraindicated with a perforated tympanic membrane.

Which OTC medication treats cerumen impaction in the external auditory canal?

A. Acetic Acid

B. Ciprofloxacin

C. Carbamide peroxide

D. Chlorphenamine

C. Carbamide Peroxide

Which condition is associated with an increased IOP due to accumulation of aqueous humor?

A. Cataract

B. Cycloplegia

C. Angioneurotic edema

D. Angle-closure Glaucoma

D. Angle closure glaucoma

Cataract - Loss of transparency

Cycloplegia - paralysis of the ciliary muscles prevent accommodation

Angioneurotic edema (angioedema)- common side effect of ocular antibiotics causes swelling of the dermis and subcutaneous tissue

Which category is the first line of drugs used primarily in the treatment of open angle glaucoma?

A. Corticosteroids

B. Cholinergic agents

C. Prostaglandin analogues

D. Carbonic anhydrase inhibitors

C. Prostaglandin Analogues

Carbonic anhydrase inhibitors last line.

Which medication is considered a first-line treatment for a child who is diagnosed with acute Otitis media?

A. Ofloxacin

B. Amoxicillin

C. Ciprofloxacin

D. Carbamide peroxide

B. Amoxicillin

Ofloacin and ciprofloxacin may be give if amoxicillin fails.

pg. 590

Which technique would a nurse use to ensure eardrums are reading the inner recesses of the external ear canal?

A. Place a wick into the edematous canal

B. Apply eardrums liberally over the tragus

C. Use an irrigation syringe to instill the eardrops

D. Call the primary health care provider and ask for systemic antibiotics.

A. Place a wick into the edematous canal. pg. 590

The nurse is teaching a patient about living with angle-closure glaucoma. Which medication classification should the patient with Glaucoma avoid?

A. Ocular Decongestants

B. Prostaglandin analogues

C. Carbonic anhydrase inhibitors

D. Nonsteroidal anti-inflammatory drugs.

A. Ocular Decongestants. pg. 583

The patient has been prescribed diclofenac sodium. The nurse recognizes that the patient has probably undergone which procedure?

A. Cataract surgery

B. Corneal ulcer surgery

C. Detached rental repair

D. Ophthalmic cancer surgery

A. Cataract surgery

Ciprofloxacin may be used for corneal ulcer surgery.

Diclofenac is not administered for retinal detachment or ophthalmic cancer. pg. 582

The nurse is teaching a student nurse about the administration of gentamicin sulfate eyedrops. Which response by the student indicates teaching was effective?

A. Gentamicin sulfate is known for being ototoxic

B. Gentamicin sulfate has limited lifetime dosage.

C. Gentamicin sulfate is know for being toxic to the eyes

D. Gentamicin sulfate is should be given for a limited number of doses preventively

A. Gentamicin sulfate is known for being ototoxic

pg. 581

Which information would the nurse include when teaching a patient about the administration of acetazolamide therapy?

A. You may have dry eyes

B. You may have blurred vision

C. You may have increased urine output

D. You may have vision problems at night

C. You may have increased urine output

Acetazolaide is a carbonic anhydrase inhibitor used to decrease intraocular pressure. It is also used as a diuretic, therefore, increased urine output.

Cyclobenzaprine is an anticholinergic used to dilate pupils, and can cause dry eyes.

Betaxolol is a beta-adrenergic blocker which causes vision problems at night.

Pg. 585, 587

The nurse instills betaxolol hydrochloride ophthalmic solution and then gently applies pressure over the inner canthus. Which phrase accurately describes the rationale for this nursing action?

A. To avoid corneal abrasion

B. To lower intraocular pressure

C. To minimize systemic absorption

D. To decrease the burning sensation

C. To minimize systemic absorption

p. 581

Which action would the nurse perform to administer eyedrops to a patient who has been prescribed timolol 1 drop in the right eye and latanoprost 1 drop in the right eye?

A. Wait 5 min. between drugs

B. Administer timolol first followed immediately by latanoprost

C. Dim light after administering drugs.

D. Obtain blood pressure before doses.

A. Wait 5 minutes between drugs p. 588

The lights would be dim if administering mydriatics.

The HCP prescribes neomycin and polymyxin B for a 6 year old who presents with acute otitis media of the right ear. Which action would the nurse perform first?

Medical history- acute otitis media (AOM) Rt ear, penicillin allergy, increased cerumen, perforated rt Tympanic membrane

Current HCP orders- remove ear wax, Admin neomycin and polymyxin B Rt ear BID, Perform audiogram to check hearing

A. Remove ear wax

B. Contact the HCP

C. Assess ear canal

D. Perform audiogram

B. Contact the HCP

Combining neomycin and polymyxin B is an effective treatment for AOM, except when the child has a prorated eardrum because this can lead to ototoxicity and permanent hearing damage. Chloramphenicol is another drug that should not be used with a perforated Tympanic membrane. Fluoroquinolones (ofloxacin) are effective and safe to use with Perforated Tympanic membrane.

The nurse is caring for a patient who is infected with herpes simplex virus. The patient subsequently develops keratoconjunctivitis. Which medication would the nurse anticipate administrating?

A. Natamycin

B. Trifluridine

C. Fomivirsen

D. Gentamicin

B. Trifluridine

Trifluridine is an antiviral medication.

Natamycin anti fungal used treat blepharitis, conjunctivitis, and keratitis caused by candida and aspergillus species. Fomivirsen is an antiviral used to treat cytomegalovirus. Gentamicin is an amino glycoside used to treat infection caused by organism such as pseudomonas, proteus, and klebsiella. pg. 581

A patient is prescribed natamycin 5% ophthalmic suspension for an external ocular fungal infection. Which allergy listed on the patient medical record indicates the patient may have sensitivity to natamycin?

A. Eggs

B. Cheese

C. Bananas

D. Grapefruit

B. Cheese

p. 581

Which action would a nurse include in the plan of care for a patient prescribed dorzolamide for the treatment of open-angle glaucoma? select all that apply

A. Assess visual acuity

B. Monitor uric acid levels

C. Change positions slowly

D. report burning with dose

E. Measure intake and output

A. Assess visual acuity

B. Monitor uric acid levels

C. Change positions slowly

E. Measure intake and output

Drozolamide is a Carbonic anhydrase inhibitor. it is also a diuretic.

Which instruction would the nurse provide to a patient who is prescribed a topical antiinfective agent for an ear infection?

A. use a portable hair dryer

B. Avoid using ear plugs when you bathe

C. Stop the medication when you feel better

D. Tilt the ear upward if water enters the ear.

A. use a portable hair dryer.

patient with ear infections should stay as dry as possible

The nurse is providing education to a patient to diagnosed with otitis externa. Which statement by the patient indicates an understanding of the treatment plan?

A. I will finish taking all the pills for my ear infection

B. I will use the eardrums in the ear canal to treat this condition

C. This is contagious, and I need to stay away from others for 24 hours

D. The cold I had last week caused this to occur; it will go away on it's own

B. I will use the ear drops in the ear canal to treat this condition

Which medication can mask infections, can delay healing, and is contraindicated for patients with untreated ocular infections?

A. Corticosteroids

B. Prostaglandin agonists

C. Beta-adrenergic Blockers

D. Carbonic anhydrase inhibitors

A. Corticosteroids

Which action would the nurse take to prevent nausea and vomiting in a patient being propped for irrigation of the ear canal?

A. Warm the irrigation solution

B. irrigate vigorously to remove cerumen

C. place the patient in the prone position

D. Premedicate the patient with an antiemetic

A. Warm the irrigation solution

pg. 592

The nurse is teaching a patient about the administration of neomycin and polymyxin B with hydrocortisone for treatment of an ear infection. Which adverse effect would the nurse include in the teaching?

A. Bleeding

B. Hearing ability

C. Superinfection I the ear

D. Burning sensation in the ear

B. Hearing ability

The patient is instructed to report any changes in hearing ability.

Chloramphenicol should be taught to monitor for bleeding and pallor because this med causes bone marrow suppression.

Ciprofloxacin- superinfection.

Acetic acid- burning and ear discomfort

Which assessment finding in a patient receiving pilocarpine would indicate a therapeutic effect of the medication?

A. complaints of dry eyes

B. pupils are dilated to 4mm

C. Pupils are constricted to 2mm

D. eyes are clear, without drainage

C. pupils are constricted to 2mm

used in open angle glaucoma

Which drug would the nurse anticipate incorporating into the plan of care for a patient diagnosed with blepharitis? Select all that apply

A. Timolol

B. Trifluridine

C. Natamycin

D. Gentamicin sulfate

E. Bacitracin

F. Tetracycline

G. Cyclosporine

D. Gentamicin Sulfate. E. Bacitracin is used to treat Blepharitis

Timolol is used to treat Glaucoma. Tetracycline is used to prevent ophthalmia neonatorum. Cyclosporine is used to treat occulant inflammation

A patient with acute otitis media is allergic to amoxicillin. Which antibiotic may be used instead of a penicillin-based drug?

A. Azithromycin

B. Ampicillin/ sulbactam

C. Piperacillin/ tazobactam

D. Amoxicillin/ Clavulanate potassium

A. Azithromycin

Azithromycin is a macrolide

The nurse is teaching a student about the administration of various eyedrops for treatment of infection. Which statement by the student indicates teaching was effective?

A. After admin of olopatadine, a stain should appear in the corner of the patient's eye.

B. After admin of fluorescein, a stain should appear in the cornea of the patient's eye.

C. After admin of cromolyn sodium, a stain should appear in the cornea of the patient's eye.

D. After admin of atropine sulfate, a stain should appear in the cornea of the patient's eye.

B. After admin of fluorescein, a stain should appear in the cornea of the patient's eye.

Cromolyn is a mast cell stabilizer treats allergic conjunctivitis.

Atropine sulfate is used to dilate pupils during an eye exam

Olopatadine is an antihistamine

A patient has been prescribed a beta- adrenergic blocking agent for treatment of ocular hypertension. Which adverse effect of the drug would the nurse monitor for in the patient?

A. Dizziness

B. Chemosis

C. Bradychardia

D. Hypotension

E. nervousness

A. Dizziness, C. Bradycardia, D. Hypotension

The nurse is teaching a patient with glaucoma. Which herbal product should the nurse include as not recommended for patients with glaucoma?

A. Garlic

B. St. John's Wort

C. Goldenseal

D. Valerian

C. Goldenseal

The nurse is showing the parent of a 2 year old child how to administer ear drops. Which are correct statement? Select all that apply

A. Pull down on auricle

B. Pull on the auricle

C. Position child's head with affected ear up

D. Warm the ear drop in the microwave prior to administration

A. Pull down on auricle

C. Position the child's head with affected ear up

Pilocarpine has which action on the eye?

A. Miosis

B. Mydriasis

C. Ciliary muscle paralysis

D. Pupillary dilation

A. Miosis

Which is the most common side effect/ adverse reaction associated with prostaglandin analogues for the treatment of glaucoma?

A. Hypokalemia

B. Renal calculi

C. Change color of iris

D. Postural hypotension

C. Change color of iris

A child is treated four times during the summer for external ear infections or swimmer's ear. The nurse teaches the family to prevent these infections by

A. refraining from any submersion in water

B. Continuing antibiotic therapy through the summer season

C. Taking high doses of vitamin c.

D. Using custom fitted ear plugs

D. Using custom fitted ear plugs

When otitis externa is caused by a fungal infection, the nurse would anticipate giving which medication?

A. Ciprofloxacin

B. Acetic acid

C. Amoxicillin

D. Azithromycin

E. Chloramphenicol

B. Acetic acid

The nurse is teaching a student nurse about the administration of betaxolol to reduce symptoms of ocular hypertension. Which statement by the student indicates teaching was effective?

A. Betaxolol works by increasing cardiac output

B. Betaxolol works by decreasing IOP.

C. Betaxolol works by increasing aqueous humor formation.

D. Betaxolol works by activating beta receptors in the ciliary body

B.. Betaxolol works by decreasing IOP.

Betaxolol is a beta adrenergic blocking drug. It is used to reduce ocular hypertension. It inhibits the binding of epinephrine to the beta receptors by blocking the beta receptors present in the ciliary body. Betaxolol blocks the activity of beta 1 receptors thereby decreasing the aqueous humor formation. Beta 1 blockers decrease blood pressure.

Which finding indicates an infection has resolved I a 4 year old child who returns for a follow up visit after treatment for acute otitis media?

A. Visible pearly white tympanic membrane

B. Medication wick fell out of the child's ear

C. Completed course of oral antibiotic therapy

D. Decreased inflammation in the Eustachian tube.

A. Visible pearly white tympanic membrane

The wick falling out indicates the infection has reduced.

Decreased inflammation indicates the infection is getting better.

The nurse is teaching a nursing student about risk factors associated with the development of acute otitis media. Which student statement indicates the teaching was effective? Select all that apply

A. Children with pets are at a higher risk for AOM

B. Children 2 years old and younger are at a higher risk for AOM

C. Children potty trained after age 3 are at a higher risk for AOM

D. Children exposed to second hand smoke are at a higher risk for AOM

E. Children not wearing ear protection while swimming are at a higher risk for AOM

F. Children attending daycare centers are at a higher risk for AOM

B. D. F.

A patient is administered echothiophate for treatment of accommodative estropia. Which phrase describes how the drug exerts its therapeutic effects?

A. Inactivates cholinersterase

B. inhibits the formation of lysozyme

C. increased the relaxation of ciliary muscles

D. Increases the production of aqueous humor

A. Inactivates cholinersterase

Echothiophate is an indirect-acting cholinergic drug used to treat accommodative esotropia, obstructive aqueous humor outflow, and open and angle-closure glaucoma. It binds and inactivates cholinesterase, an enzyme that breaks down acetylcholine.

The patient has had natamycin added to the treatment regimen. The patient complains to the nurse of experiencing a stinging or burning sensation. What does the nurse suspect the patient is experiencing?

A) an allergic reaction to the medication
B) an expected side effect of the medication
C) an idiosyncratic reaction to the medication
D) an overdosage of the medication

B) an expected side effect of the medication

Transient stinging or burning is known to be a usual side effect associated with use of this particular medication. It is not considered to be indicative of an allergic response, an overdosage of the medication, or an idiosyncratic reaction.

The patient tells the nurse "I have had such good results from using the gentamicin sulfate eyedrops! Could I keep taking them prophylactically as prevention against future infection?" The nurse bases her response on the knowledge that:

A) the medication is known for being ototoxic
B) the medication is known for being toxic to the eyes
C) the medication has a limited lifetime dosage
D) the medication should be given for a limited number of doses preventatively

A) the medication is known for being ototoxic

The medication is known for being ototoxic (toxic to the ears), not ophthalmically toxic (toxic to the eyes).

The nurse evaluates the patient using eyedrops. The patient puts two drops into his eye. What is the nurse's best action?

A) continue to observe the patient
B) instruct the patient that one drop is optimal
C) have the patient irrigate his eye to remove excess medication
D) have the patient close his eye and rub to assist in absorption

B) instruct the patient that one drop is optimal

One drop of eye medication is the preferred amount with prescriptions as the second drop may cause overflow. The patient does not need to irrigate his eye. Excess medication will run out. The patient should not rub his eye.

Which patient statement indicates to the nurse a need for further teaching regarding proper administration of eye drops?

A) "I will put pressure on the inside corner of my eye after I administer the drops"
B) "I will be careful not to touch my eye with the dropper"
C) "I should rinse the eye dropper with tap water after each use"
D) "I will turn my head slightly toward the outside of the eye I am putting the drops in"

C) "I should rinse the eye dropper with tap water after each use"

It is important to maintain sterility of the eye drop container, and therefore it should not be rinsed; the cap should be put immediately back on the container.

The nurse is planning to administer eardrops. What intervention is essential to include in the plan of care?

A) eardrops should be cool when being administered
B) warm the eardrops to room temperature before administration
C) the pinna of an adult should be held down and back to administer eardrops
D) eardrops may be warmed in the microwave before administration

B) warm the eardrops to room temperature before administration

Eardrops should be warmed to room temperature before administration to avoid unpleasant symptoms from cool ear drops. Eardrops that are administered too cold may cause vomiting and dizziness by stimulating a vestibular-type reaction. Cool eardrops should not be administered. The pinna should be held up and out in an adult. Eardrops should not be warmed in the microwave because too high a temperature can destroy the effectiveness of the medication.

The patient has been ordered diclofenac sodium. The nurse recognizes that the patient has probably undergone which procedure?

A) surgery for corneal ulcers
B) cataract surgery
C) surgery for a detached retina
D) surgery for ophthalmic cancer

B) cataract surgery

Diclofenac sodium is used after the patient has undergone cataract surgery.

The nurse administers pilocarpine to a patient with glaucoma. What assessment finding would indicate a therapeutic effect of the medication?

A) patient's eyes appear clear, without drainage
B) patient states that her eyes feel very dry
C) patient's pupils are dilated to 4 mm
D) patient's pupils are constricted to 2 mm

D) patient's pupils are constricted to 2 mm

Pilocarpine is a direct-acting parasympathomimetic agent that is used as a miotic in the treatment of open-angle glaucoma. Miosis causes pupillary constriction, increasing the outflow of aqueous humor. This medication will not decrease drainage, cause excessive drying, or dilate the pupils.

The nurse is caring for a patient who is a new mother. The patient tells the nurse, "I saw the nurses put some kind of drops in my baby's eyes after she was born. Could those drops damage her eyes?" The nurse frames a response based on the knowledge that:

A) the medication was likely given to enhance the newborn's visual acuity
B) the nurse should ask the health care provider why the medication was given
C) the medication was likely given to prevent infection of the newborn's eyes
D) the eyedrops can cause short-term changes to the newborn's vision

C) the medication was likely given to prevent infection of the newborn's eyes

The drops were most likely given to prevent infection of the newborn's eyes, such as ophthalmia neonatorum. They are not known to enhance the baby's visual acuity nor to cause short-term changes to the vision.

A patient is complaining of excessive earwax that diminishes hearing ability. Which medication will the nurse use to assist the patient?

A) acetic acid (vinegar)
B) carbamide peroxide
C) hydrocortisone
D) glycerin

B) carbamide peroxide

Carbamide peroxide works to soften earwax for easy removal while providing a weak antibacterial action to prevent infection. The nurse should not utilize glycerin, hydrocortisone, or acetic acid in trying to soften earwax.

The patient has experienced an ophthalmic infection that has not responded to the usual antibiotics administered. What medication does the nurse anticipate that the provider will order?

A) tetracycline
B) diclofenac sodium
C) chloramphenicol
D) gentamicin sulfate

C) chloramphenicol

Chloramphenicol is used to treat severe ophthalmic infections that are not responsive to other antibiotics. Tetracycline is used to prevent ophthalmia neonatorum. Diclofenac sodium is used after cataract surgery. Gentamycin sulfate may result in ototoxicity.

A patient receiving otic antimicrobial therapy has a decrease in leukocytes, erythrocytes and platelets. Which drug is most likely causing bone marrow suppression?

A. Furosemide

B. Ciprofloxcin

C. Chloramphenicol

D. Prednisolone sodium phosphate

C. Chloramphenicol

Ciprofloxacin is an antimicrobial and common side effects nausea, diarrhea, headache, and difficulty sleeping. Prednisolone sodium phosphate is a corticosteroid and can mask infections, used for allergies.

Which condition is a contraindication for timolol? Select all that apply

A. Glaucoma

B. Heart failure

C. Cardiogenic shock

D. Ocular hypertension

E Atrioventricular AV block

F. Chronic Obstructive pulmonary disease

B. Heart failure

C. Cardiogenic shock

E. Atrioventricular block

F. COPD

Timolol is a beta-adrenergic blocker used to treat glaucoma and ocular hypertension. Pt with these conditions should not receive beta-adrenergic blockers.

Which information is most important for the nurse to provide the parents of a child prescribed amoxicillin for the treatment of acute otitis media?

A. Remove all water from within ear canal

B. Administer acetaminophen for pain

C. Complete the entire course of antibiotics

D. Report nausea, vomiting, diarrhea

C. complete the entire course of antibiotics

Which medication is used to treat age-related macular degeneration?

A. Epinastine

B. Ciprofloxacin

C. Bevacizumab

D. Brimonidine

C. Bevacizumab

Bevacizumab is an intravitreal drug that targets vascular endothelial growth factor and prevents formation of abnormal blood vessels in the eye. other examples ranibizumab, pegaptanib, aflibercept.

VEGF are contraindicated in people with ocular infections. There is no known treatment or medication for dry macular degeneration. Drusen- extracellular material under the retina.

Which herb would the nurse instruct a patient with glaucoma to avoid? select all that apply

A. Coffee

B. Bitter Orange

C. Blood root

D. Bilberry

E. Ginko Biloba

F. Jimsonweed

A. Coffee, B. Bitter Orange, C. Blood Root, F. Jimsonweed

Which information would the nurse include when teaching the patient about receiving topical anesthetic before an ocular procedure? Select all that apply

A. Blink reflex is temporarily lost

B. They block pain signals at the eye's nerve endings

C. They begin to take effect in 30 to 45 minutes

D. Contact lens may be reinserted after anesthesia has completely worn off

E. The affected eye will be sensitive so the patient should wipe with warm moistened washcloth.

A. B. D.

The nurse is providing instructions to an older patient regarding use of eyedrops I the home setting. The patient states I hope I can remember to do all of this stuff you are telling me. Which action would the nurse take?

A. provide written instruction

B. Call the HCP and report the Pt is confused

C. Notify adult protective services that the patient is unsafe at home

D. Remind the patient the instructions can be found on the internet.

A. Provide written instructions

Which information would the nurse provide to a patient about the pharmacologic treatment for wet-age-related macular degeneration?

A. The drugs constrict the pupil and contract the ciliary muscle

B. The drugs prohibit the growth of abnormal blood vessels I the retina

C. The drugs prevent enzymatic destruction of acetylcholine within the eye

D. The drugs decrease production of aqueous humor and intraocular pressure.

B.

Which action would a nurse include in the plan of care for a patient prescribed dorzolamide for treatment of open angle glaucoma?

Select all that apply

A. Assess visual acuity

B. Monitor uric acid levels

C. Change postions slowly

D. Report burning with dose

E. Measure intake and output

A. Assess visual acuity

B. Monitor uric acid levels

C. Change positions slowly

E. Measure intake and output

Dorzolamide is a carbonic anhydrase inhibitor that decreases aqueous humor production, and it is a diuretic. Burning sensation is a side effect.

Which disorder is related to dysfunction of the eustachian canal?

A. Psoriasis

B. Seborrhea

C. Otitis Media

D. Otitis externa

C. Otitis media

Which information is most important for a nurse to provide a patient receiving prednisolone acetate for a corneal abrasion in order to prevent complications?

A. Ocular corticosteroids can delay healing

B. Cold medication can increase eye pressure

C. Hand washing should occur before and after instilling drops

D. Drugs should be instilled in conjunctival sac

C. Hand washing should occur before and after instilling drops

Which glaucoma drugs decrease intraocular pressure by decreasing the production of aqueous humor?

A. Cycloplegia agents

B. Cholinesterase inhibitors

C. Prostaglandin analogues

D. Carbonic anhydrase inhibitors

D. Carbonic anhydrase inhibitors such as brinzolamide. Cycloplegia agent paralyze the muscle of accommodation.

Colinesterase inhibitors inactivate the enzyme cholinesterase the typically breaks down acetycholine. Prostaglandin improves trabecular outflow and by increasing the uveoscleral pathway