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    Glaucoma: Zarieh Dawn Novela Medicine 2

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    Zari Novela
    Glaucoma is a group of eye diseases that damage the optic nerve and can cause vision loss and blindness. It is often associated with increased pressure inside the eye. The normal intraocular pressure is 15mmHg and 21mmHg is considered suspicious for glaucoma. Primary open angle glaucoma is the most common type, where the angle is open but there is impediment to fluid outflow through the trabecular meshwork. Treatment depends on the type of glaucoma but generally involves medical therapy to lower pressure and sometimes surgery.

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    Glaucoma: Zarieh Dawn Novela Medicine 2

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    Zari Novela
    287 views41 pages
    Glaucoma is a group of eye diseases that damage the optic nerve and can cause vision loss and blindness. It is often associated with increased pressure inside the eye. The normal intraocular pressure is 15mmHg and 21mmHg is considered suspicious for glaucoma. Primary open angle glaucoma is the most common type, where the angle is open but there is impediment to fluid outflow through the trabecular meshwork. Treatment depends on the type of glaucoma but generally involves medical therapy to lower pressure and sometimes surgery.

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    eye retinopathy, eye disorder, opthalmology, only about glaucoma and its forms

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    Glaucoma

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    Glaucoma is a group of eye diseases that damage the optic nerve and can cause vision loss and blindness. It is often associated with increased pressure inside the eye. The normal intraocular pressure is 15mmHg and 21mmHg is considered suspicious for glaucoma. Primary open angle glaucoma is the most common type, where the angle is open but there is impediment to fluid outflow through the trabecular meshwork. Treatment depends on the type of glaucoma but generally involves medical therapy to lower pressure and sometimes surgery.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    287 views41 pages

    Glaucoma: Zarieh Dawn Novela Medicine 2

    Uploaded by

    Zari Novela
    Glaucoma is a group of eye diseases that damage the optic nerve and can cause vision loss and blindness. It is often associated with increased pressure inside the eye. The normal intraocular pressure is 15mmHg and 21mmHg is considered suspicious for glaucoma. Primary open angle glaucoma is the most common type, where the angle is open but there is impediment to fluid outflow through the trabecular meshwork. Treatment depends on the type of glaucoma but generally involves medical therapy to lower pressure and sometimes surgery.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 41

    Glaucoma

    Zarieh Dawn Novela Medicine 2

    Glaucoma
    The term glaucoma covers several diseases with differing etiologies that share the common finding of optic neuropathy with characteristic pathologic findings in the optic nerve head and a specific pattern of visual field defects. The disease is often, but not always, associated with increased intraocular pressure. The final stage of glaucoma is blindness. Primary glaucoma
    refers to glaucoma that is not caused by other ocular disorders.

    Secondary glaucoma
    may occur as the result of another ocular disorder or as an undesired side effect of medication or other treatment.

    Epidemiology
    Throughout the world, there are about 70M people suffering from glaucoma and 7 M who have been blinded by the disease. Glaucoma is the second most frequent cause of blindness in developing countries after diabetes mellitus. Some 1520% of blind persons have lost their eyesight as a result of glaucoma.

    Intraocular pressure
    Normal IOP: 15mmHg 21mmHg is regarded as suspect for glaucoma Regulation of IOP is by the anterior segment of the eye Incd IOP in granuloma is dt:
    Abnormal aqueous outflow Rarely, to over production Most rarely, to incd venous back pressure

    1-2% of total anterior and posterior chamber (0.2-0.4mL) is replaced at rate of 2-6 uL. Physiologic resistance from pupil and trabecular meshwork

    Effect of IOP
    Ultimately manifested in optic disk Causes ischemia by impairing blood supply to optic nerve impairs nutrition of glial cells Causes acute optic neuropathy
    Edema Small hemorrhage in optic disc Loss of nerve fiber bundle configuration

    Symptomatology
    2 sources
    Increased IOP Disturbance of optic nerve function (show little defects)

    Acute glaucoma (as in acute angle glaucoma)


    Severe ocular pain Sudden diminution of vision Seeing haloes aroung light Ciliary injection Lacrimation Sphincter ms of iris is paralyzed causing pupillary dilatation

    Chronic glaucoma (as in chronic angle closure)


    Gradual closure of angle Gradual inc in IOP Symptoms may be absent

    Diagnostic methods
    Suspicion for glaucoma
    Normal IOP but disc is cupped or pale Normal disc but IOP is 21mmHg

    Tonometry
    Measurement of IOP 2 types:
    Indentation tonometer of Schiotz most affordable Applanation tonometer most accurate, but expensive

    measures the degree to which the cornea can be indented in the supine patient The lower the IOP, the deeper the tonometer pin sinks and the greater distance the needle moves.

    most common method of measuring IOP. It permits the examiner to obtain a measurement on a sitting patient within a few seconds

    Diagnostic methods
    Optic disc ophthalmoscopy The optic disc has a physiologic indentation known as the optic cup. In the presence of persistently elevated IOP, the optic cup becomes enlarged and can be evaluated by ophthalmoscopy. vertical elongation of the optic cup seen in eyes with glaucoma.

    Diagnostic methods
    Optic disc ophthalmoscopic findings w/ glaucoma Optic disc w/ vertically oval and notched cup Nasalization of central vessels Circumpapillary halo Spontaneous pulse in central retinal artery Extension of cup border to any part Hemorrhage in disc in absence of hemorrhage in any parts of fundus

    Primary angle closure glaucoma


    IOP incd because aqueous could not flow to trabecular meshwork due to apposition of iris to anterior chamber angle
    Angle: blocked Outflow impediment: iris tissue occluded the trabecular meshwork

    Mc form of glaucoma (90%) Incidence increases over age 60 3x more in female

    Primary angle closure glaucoma


    Etiology Anatomically predisposed eyes with shallow anterior chambers pose a relative impediment to the flow of aqueous humor through the pupil. This pupillary block increases the pressure in the posterior chamber The pressure displaces the iris anteriorly toward the trabecular meshwork, suddenly blocking the outflow of aqueous humor (angle closure).

    Primary angle closure glaucoma


    Signs and symptoms
    Sudden diminution of vision w/ prodromes of seeing haloes around lights Pain on or around eye Parasympa stimultion in form of nausea, vomiting and abdominal pain Ciliary congestion Corneal edema Shallow anterior chamber w/ aqueous flare and cells Dilated pupil Sector iris atrophy Firm eyebal

    Primary angle closure glaucoma


    Treatment An acute glaucoma attack is an emergency, and the patient requires immediate treatment by an ophthalmologist. Medical therapy. The goals of conservative therapy are:
    Decrease intraocular pressure. Allow the cornea to clear (important for subsequent surgery). Relieve pain.

    Primary angle closure glaucoma


    Treatment Principles of medical therapy in primary angle closure glaucoma
    Osmotic reduction in the volume of the vitreous body is achieved via systemic hyperosmotic solutions (oral glycerin, 1.01.5 g/kg of bodyweight, or IV mannitol, 1.02.0 g/kg of body weight). Production of aqueous humor is decreased by inhibiting carbonic anhydrase (IV acetazolamide, 250500 mg). Both steps are taken initially to reduce intraocular pressure to below 50 60mmHg.

    Secondary angle closure glaucoma


    Same as in primary angle closure glaucoma,the increase in IOP is due to blockage of the trabecular meshwork.
    Angle: blocked Outflow impediment: displacement of trabecular meshwork produces anterior synechiae, scarring and neurovasularization

    Most important cause: rubeosis iridis

    Secondary angle closure glaucoma


    Treatment Secondary glaucomas can be caused by many different factors, and the angle may be open or closed. Therefore, treatment will depend on the etiology of the glaucoma. The underlying disorder is best treated first. Glaucomas with uveitis (such as iritis or iridocyclitis) initially are treated conservatively with anti-inflammatory and antiglaucoma agents. Surgery is indicated where conservative treatment is not sufficient. The prognosis for secondary glaucomas is generally poorer than that for primary glaucomas.

    Primary open angle glaucoma


    Aqueous has access to anterior chamber all the time.
    Angle: completely open Outflow impediment: in trabecular meshwork

    MC form of glaucoma (90%) Incidence incs over age 0f 40 There appears to be a genetic predisposition Signs and symptoms
    The majority of patients do not experience any subjective symptoms for years. However, may experience occasional unspecific symptoms such as headache, a burning sensation in the eyes, or blurred or decreased vision may also perceive rings of color around light sources at night

    Secondary open angle glaucoma


    The anatomic relationships bw the root of the iris, the trabecular meshwork, and peripheral cornea are not disturbed. However, the trabecular meshwork is congested and the resistance to drainage is increased.
    Angle: completely open Outflow impediment: Erythrocytes, pigment, and inflammatory cells occlude the trabecular meshwork

    Primary infantile glaucoma


    Angle: undifferentiated Outflow impediment: In the trabecular meshwork (which is not fully differentiated and/or is occluded by embryonic tissue)

    Recessive type of inheritance S&S:


    Lacrimation Blepharospasm Photophobia Corneal enlargement Glaucomatous cupping Tx: surgical - goniotomy

    Glaucoma asso w/ Hereditary or Familial Dse


    Marfans syndrome
    Arachnodectyly Cardiac anomalies lens subluxation

    Axenfeld syndrome
    Corneal arcus (posterior embryotoxon) Ectopia of pupil Polycoria Hypoplasia of anterior iris

    Sturge-Weber syndrome/ Encephalofacial hemangioma Neurofibromatosis Marchesani syndrome (Spherophakia)


    Highly myopic Brachycephalic Short and stocky w/ short fingers

    Aniridia

    Quiz Time!

    Now, Eyem gonna ask questions coz Eye saw you listening

    No. 1
    What is the normal IOP? What IOP is regarded as suspicious for glaucoma?

    No. 2
    Discuss briefly the aqueous humor circulation.

    No. 3
    What do you call this diagnostic method? What does it do?

    No. 4
    What type of glaucoma is this?

    No. 5
    Most important cause of secondary angle closure glaucoma?

    No. 6
    Where is the outflow impediment in primary open angle glaucoma?

    No. 7
    Give 1 glaucoma associated with hereditary or familial disease?

    No. 8
    What type of glaucoma is this?

    No. 9
    Most common type of glaucoma?

    No. 10
    Did you learn?

    Thank you!

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