Which option is a systemic carbonic anhydrase inhibitor used in glaucoma management?

• A. Timolol
• B. Latanoprost
• C. Dorzolamide
• D. Diamox

Answer: (D)

Systemic carbonic anhydrase inhibitors lower intraocular pressure by blocking carbonic anhydrase in the ciliary processes, which reduces bicarbonate formation and decreases aqueous humor production. acetazolamide, taken systemically as Diamox, is the classic systemic CAI used to acutely lower IOP or as an adjunct when topical therapy isn’t enough. Other options act via different mechanisms or routes: a topical beta-blocker reduces aqueous production but isn’t systemic CAI; a prostaglandin analog increases outflow rather than inhibiting production systemically; a topical carbonic anhydrase inhibitor lowers IOP locally, not systemically. Diamox thus best fits the systemic CAI category. Be aware of potential side effects like metabolic acidosis, electrolyte disturbances, kidney stones, and caution in sulfa allergies or renal impairment.