Scribd
Upload
99 views43 pages

Eye Department Queen Elizabeth Hospital

Glaucoma is a group of eye diseases characterized by optic nerve damage and visual field loss caused by abnormally high intraocular pressure. It is the second leading cause of blindness worldwide. The most common type is primary open-angle glaucoma which develops slowly over time. Left untreated, glaucoma can lead to permanent vision loss. Treatment aims to lower intraocular pressure through medications, laser treatments, or surgery. Regular eye exams are important for monitoring the condition and preventing vision loss.

Uploaded by

arnol3090
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
99 views43 pages

Eye Department Queen Elizabeth Hospital

Glaucoma is a group of eye diseases characterized by optic nerve damage and visual field loss caused by abnormally high intraocular pressure. It is the second leading cause of blindness worldwide. The most common type is primary open-angle glaucoma which develops slowly over time. Left untreated, glaucoma can lead to permanent vision loss. Treatment aims to lower intraocular pressure through medications, laser treatments, or surgery. Regular eye exams are important for monitoring the condition and preventing vision loss.

Uploaded by

arnol3090
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
You are on page 1/ 43

Eye Department

Queen Elizabeth Hospital


What is Glaucoma?
• Not a single disease entity
• Comprise of abnormalities involving
– High intraoccular pressure
– Optic nerve head pathology
– Visual field defect
Statistics
• Potential visual loss if left untreated- the
second leading cause of blindness
• In US, approximately 1 in 50 Americans
above the age of 35 have this condition
• The incidence increases with age
• Causes considerable visual morbidity
• The cost in human and financial terms of
this disease is considerable
Anatomy

• Production vs Outflow
Physiology
Pathology
• Outflow obstruction
• Rarely, overproduction
• Nervous tissue destruction
• Mechanism yet uncertain.
Instruments useful for glaucoma
• Slit lamp Tonometer
Instruments useful for glaucoma

• Gonioscopy
Perimetry
Classification
G la u c o m a

C o n g e n it a l A c q u ir e d
O R in fa n t ile

P r im a r y S e c o n d a ry

O p e n A n g le A n g le C lo s u r e
(P O A G )
Primary Open Angle Glaucoma
• The most common type of glaucoma
• Incidence: 0.25 - 0.75% of the population
• In most cases develops in the middle age or later
• Tends to be familial
• Onset is gradual and slowly progressive
• Usually silent & insidious. Chronic, progressive &
bilateral in >40yo
• Family history
• Symptoms and signs typically few and late
• Symptoms:
– Very vague, non specific
– Headache
– Eye pain/discomfort
– Halos
– Blurry vision
– Focussing problems
– Takes a while for the patient to become
suspicious. Total loss of vision in one eye may
remain un-noticed in some patients
• Not all ocular discomfort are secondary to
glaucoma
Primary Open Angle Glaucoma
• Signs:
• RAPD
• Tonometry – high IOP >21mm Hg
• Fundoscopy – Optic nerve may be:
– Cupped > 0.3 disc
– Pale or atrophic
• Visual field
– Constricted, tunnel vision
– Paracentral scotoma
• Angles open
Differential diagnosis
• Low tension glaucoma
• Ocular hypertension
• Intermittent angle closure glaucoma
Primary angle closure glaucoma

• Angle configuration:
– Appositional
– Synechia
• There are 3 subtypes:
– Acute
– Subacute
– Chronic
Acute subtype
• IOP increase rapidly due to pupillary block

• Symptoms:
– severe pain
– blurred vision
– coloured haloes around light
– nausea and/or vomiting
Angle Closure
Glaucoma
• Signs:
– Conjunctiva – ciliary injection
– Hazy cornea, bullous
keratopathy, halo
– Pupils middilated, irregular,
sluggish or non reactive
– IOP is very high, usually >30
– AC is shallow during
gonioscopy
– Inflammation: flares, cells
• Eye Sight may be lost without
urgent prompt treatment.
Subacute and chronic subtype

• The IOP increases more gradually in these


conditions because the angle is not totally
blocked
• The patient present with intermittent elevation of
IOP which revert spontaneously
• Symptoms occurs in dim lighted environment or
other condition where the pupil in mid-dilated
position
CONGENITAL GLAUCOMA

• Should be suspected
• in ALL babies with:
• large eyeballs
• large cornea
• hazy cornea
• photophobia
• excessive tearing
Secondary glaucoma
• Caused by another pathology
• Examples:
• Pigment dispersion syndrome
• Pseudoexfoliation syndrome
• Trauma-related glaucoma
• Cataract/lens induced
Fundoscopy - Changes in the
Optic Disc

• Cup ratio
• Pallor
Anatomy of nerve fiber layer
Progress of field loss
Treatment

• The aim of treatment is to lower the IOP to a level


where further visual loss does not occur.
• The management plan depends on whether or not
visual loss exists.
• In all cases of glaucoma, it is essential to establish
whether the glaucoma is open or closed angle type.
• In open angle glaucoma, the first line of therapy is
medical treatment
• The second line of treatment is surgical, to which,
recently laser therapy has been added.
• Closed angle glaucoma may initially be treated
medically, but primarily it require peripheral iridectomy
(laser or surgical) to relieve pupillary block
mechanism.
Medical treatment
• Topical

• Systemic
Overview of medical treatment
Beta blockers
• Examples: timolol, betaxolol,
• Mechanism of action : reduce aqueous
production
• Indications:
– Primary and secondary glaucomas
– Congenital glaucoma
• Contraindications:
– Chronic lung diseases
– Heart block
– Congestive Heart Failure
Cholinergic agents
• Eg: Miotics: pilocarpine
• Mechanism of action:
• Increases outflow facility
• miosis
• Indications:
Chronic open angle glaucoma
• Acute closed angle glaucoma
• Contraindications:
• Ocular inflammation
• Known allergy
Carbonic anhydrase inhibitors
• Systemic: acetazolamide
• Topical: Dorsolamide
• Mechanism of action:
• Reduces aqueous production
• Indication
• Adjunctive therapy
• Contraindication
• Known allergy
• Renal diseases
Hyperosmotic Agents
• e.g. Mannitol, glycerin, isosorbide
• Mechanism of action: increases plasma tonicity and
draw water out of the eye
• Indications: Additive therapy for rapid lowering of IOP
• Side Effects:
• HPT aggravation
• nausea
• vomiting
• CCF
• Pulmonary oedema
Non medical treatment

• Laser
– Iridotomy
– Iridoplasty
– Pupilloplasty
– Trabeculoplasty
Surgery

• In open angle glaucoma, surgery is performed


when the medical and/or laser therapy fails.
• The surgery results in a bypass of the
conventional outflow pathways and allows
drainage of the aqueous from the eye
• Usually called filtration surgery
• Types
– Trabeculectomy
– Drainage implant
– Goniotomy
– Surgical peripheral iridectomy
• Use of antimetabolites e.g. mitomycin
Trabeculectomy
Peripheral • Trabeculectom
Iridectomy y
Valve inplant
Goniotomy
Following up patients
• IOP check at regular intervals
• Perimetry
• Observe changes in the optic disc with
time: pallor and CD ratio
• Open angle glaucoma tend to be lifelong
followup
Absolute Glaucoma
• End stage of neglected untreated
glaucoma
• Absent light perception
• High IOP – eye ball is stony hard
• May be painful
• Treatment:
– Alcohol injection
– Cyclocryotherapy
– Evisceration/ Enucleation
Take home message
• Be familiar with using a Schiotz tonometer
and a fundoscope
• Know when to suspect glaucoma
• Urgent referral for closed angle glaucoma

You might also like