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
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)
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