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GLAUCOMA
Dr. Wah Wah Lwin
Associate Professor • Glaucoma is a progressive optic neuropathy with characteristic changes in optic nerve head and corresponding loss of visual field
• Raised IOP is most important risk factor
(Normal IOP = 11-21 mmHg)
• 2nd leading cause of blindness worldwide
Increasing optic disc cup Progressive thinning of neuroretinal rim Changes in optic nerve head Lamellar Dot Sign Aqueous secretion and drainage Aqueous is secreted from ciliary body and drains through the AC angle
Route of aqueous outflow
a. trabecular b. uveosclera c. iris TYPES According to with or without underlying disease • Primary (no underlying eye disease) • Secondary (with underlying eye disease) Eg, LIG (lens induced glaucoma) PDS (pigment dispersion syndrome) NVG (neovascular glaucoma) TYPES According to angle structure • Open angle glaucoma • Angle closure glaucoma Ocular hypertension • IOP> 21mmHg without detectable glaucomatous changes on standard clinical tests
Normal tension glaucoma
• A mean IOP <21mmHg on diurnal testing. Glaucomatous optic disc damage and visual field loss and open drainage angle on gonioscopy, absence of secondary causes for glaucomatous optic disc damage Primary open angle glaucoma • Known as chronic simple glaucoma • Affects both sex equally • IOP >21mmHg • Glaucomatous optic nerve damage • An open normal appearing anterior chamber angle • Characteristics visual field loss • Absence of sign of secondary glaucoma or a non- glaucomatous cause for optic neuropathy Primary angle closure glaucoma (PACG)
Angle closure - refers to occlusion of trabecular meshwork by the peripheral iris obstructing the aqueous outflow.
- PACG – responsible for up to half of all cases of