GLAUCOMA

DEFINITION

#Optic nerve damage characterized by optic disc cupping and visual field loss in which the raised in the intraocular pressure is the most important risk factor.

#Intraocular pressure 

– The pressure in the eyeball

–Dependent on balance between amount of aqueous production by ciliary process  and the rate of aqueous outflow through trabecular meshwork.

#Optic nerve damage is irreversible (permanent)

PRIMARY OPEN ANGLE GLAUCOMA

Chronic slowly progressive optic nerve damage.

Risks factor

–Incidence increase with age (affect 0.5% - 1% of population > 40 yrs)

–Family history of glaucoma

–Systemic vascular disease eg.DM, HPT

Symptoms delayed in the diagnosis

Asymptomatic / Painless

Reduced vision (late stage)

Constricted visual field (late stage)

ANGLE CLOSURE GLAUCOMA

Sudden raised in intraocular pressure

It is ocular emergency

If IOP is not reduced within few hours, irreversible damage to optic nerve will occur

SYMPTOMS
Sudden reduced vision
Pain
Headache ± vomiting 

SIGNS
Poor vision
Congested conjunctiva
Hazy cornea
Shallow anterior chamber
Middilated, nonreactive pupil
Very high IOP

CONGENITAL GLAUCOMA

SYMPTOMS 

Watery eyes

Photophobia

SIGNS

Buphthalmos 

Hazy cornea

High IOP

Aim of treatment

–To preserve visual function and preventing further optic nerve damage

GLAUCOMA – TREATMENT :MEDICAL

TOPICAL (EYE DROP)

B- Blocker – reduced aqueous production

–Eg: gutt timolol

Parasympathomimetic – increase the rate of aqueous outflow

–Eg: gutt pilocarpine

Carbonic anhydrase inhibitor – reduced aqueous production

–Eg: gutt dorzolamide (trusopt)

Prostaglandin analog – increase aqueous outflow

–Eg: gutt latanaprost (xalatan)

SYSTEMIC

Carbonic anhydrase inhibitor

–Oral / intravenous acetazolamide (diamox)

Oral glyserol

Intravenous mannitol

GLAUCOMA – TREATMENT :LASER

LASER IRIDOTOMY

Treatment for angle closure glaucoma

Small opening on the iris is made using LASER to allow aqueous to pass directly from posterior chamber to anterior chamber (bypass the pupil).

GLAUCOMA – TREATMENT :SURGERY

TRABECULECTOMY

A block of trabecular meshwork is removed to make a fistula direct from the anterior chamber to the subconjunctival space (bypass trabecular meshwork)