Beruflich Dokumente
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Anatomy of Angle of
Anterior Chamber
A/C is bounded in
front by the
cornea, behind by
the iris and the
part of the
anterior surface
of the lens which
is exposed in the
pupil.
Its peripheral
recess is known
as the angle of
the A/C, bounded
posteriorly by the
root of the iris
and ciliary body
and anteriorly by
the corneoscleral
junction.
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Aqueous is
produced by
ultrafiltration and
secretion from
ciliary processes
and passes into
the posterior
chamber.
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IOP
Normal IOP varies between 14-22
mmHg and is not maintained at a
constant level throughout the day,
because of the variations which occur
during 24 hours, so called diurnal
variation. Normal diurnal variation is
usually 3-5 mmHg.
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(ii) Tonometry
Indentation,
Schiotz
Applanation
Goldman,
Indentation tonometry
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Applanation tonometry
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Applanation tonometry
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Tonometers
The tono-pen.
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Tonometers
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Definition of Glaucoma
Glaucoma is a chronic progressive
optic europathy caused by a group of
ocular conditions which lead to
damage of the optic nerve with loss of
visual function
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Classification of Glaucoma
1. Congenital
2. Acquired : Acquired can be
(a) Primary
(b) Secondary
Primary is again divided depending upon
configuration of angle of A/C into
(i) Angle closure or narrow angle glaucoma
(where angle is less than 20) or congestive
glaucoma; and
(ii) Open angle or Chronic simple or Wide angle
glaucoma where angle is normal, i.e. more than
20.
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ANGLE CLOSURE
GLAUCOMA
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Aetiopathology:
Aetiopathology
Predisposing factors
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Goniolenses
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Normal Gonioscopic
Findings
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Angle AC
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Normal Gonioscopic
Findings
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In an eye having a
configuration liable to closed
angle glaucoma with its
shallow A/C and anteriorly
placed iris lens diaphragm,
iris is rather more closely
opposed to the lens making
communication between
anterior and posterior
chamber through the pupil
therefore difficult so that a
condition of relative pupillary
block exists and so there is
collection of aquous in the
posterior chamber.
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Clinical features
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Prodromal stage
In this stage occasional attacks of raised
tension occurs, giving risk to following
symptoms :
Transient attacks of blurring of vision and
appearance of coloured halos around light
due to corneal oedema.
Occasionally associated with headache
also.
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Stage of constant
instability
In this stage intermittency in these
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On Examination:
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Typical signs of
previous acute or
subacute angleclosure attacks. (a)
Patchy iris atrophy. (b)
Torsion of the iris. (c)
Subcapsular,
speckled anterior lens
opacities
(glaucomflecken).
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4) Chronic congestive
stage
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On Examination:
5) Absolute stage
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On Examination:
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D/D :
Acute Conjunctivitis
Acute iritis
Acute Glaucoma
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Diagnosis
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Acute
conjunctivitis
Acute iritis
Acute glaucoma
Discharge
Moderate to
profuse
None
None
Vision
Normal
Blurred
Markedly blurred
Pain
None
Moderate
Severe
Congestion
Conjunctival
Circumcorneal
Circumcorneal
Cornea
Clear
Steamy
A/C
Normal in depth
very shallow
Angle of A/C
by
gonioscopy
Normal
Normal
Narrow or closed
Normal
IOP
Normal
Always raised
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Provocative tests
Priscol test,
Mydriatic test
Water drinking test
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(8 mm in hr):
Patient is placed in a dark room for half an
hour so that pupil dilates. But he must
remain awake.
IOP is recorded before and after placing
the patient in dark room for an hour a
rise in IOP of more than 8 mm of Hg is
considered pathological.
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Mydriatic test
(5 mm
n 1 hr):
In mydriatic test pupil is dilated by a mild mydriatic
such as phenylepherine or tropicamide but if these
give a negative result even homotropine can be
used but always with a caution.
Tonometric readings are taken every 15 minutes
for 1 hour a rise of IOP of more than 5 mm of Hg
is pathological.
After mydriatic test is over it should always be
ascertained by the surgeon that full vision of the
pupil has been achieved.
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Priscol test
(14 mm in 1 hr):
In priscol test, 10 mgm of prisol is injected
S/C
A rise of IOP greater than 14 mm of HG
within 60 minutes is pathological.
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Treatment
Medical treatment
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Treatment of acute
congestive stage : Medical
and
Surgical
Medical
treatment
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ii) Miotics
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c) Mannitol 20%
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Surgical Treatment
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Treatment of chronic
congestive stage
1.
2.
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Treatment of absolute
stage
Main symptom here is pain, though eye has got
no vision
Cyclodestructive procedure
1.
Cyclodiatheramy
2.
Cyclocryotherapy
3.
Laser cyclophoto-coagulation can be done to
reduce IOP.
Chronic simple
glaucoma or open
angle or wide angle
glaucoma
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Narrow angle
Open angle
Age
Sex
Common in male
Personality
Anxious personality
with an unstable
vasomotor system
Type of eye
Specifically seen in
narrow angled eye
Symptoms
and course
No symptoms are
experienced generally and
disease runs a slowly
progressing course.
Field defect
and cupping
Treatment: .................
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Aetiopathogenesis
Clinical fatures
Symptoms
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Normal vision
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Signs:
Triad of signs is present :
(1) Increased IOP,
(2) Glaucomatous cupping of optic disk,
(3) Visual field loss.
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Enlarged cup
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Asymmetry of cup
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Glaucomatous
Deep physiological
excavation reaches up to
edge of the disc
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Usually vertically oval and
Not so
Continuity in vessels is
not proper at disc
margins and no parallex
can be elicited.
margins to reappear at
base again and definite
parellex can be elicited
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If arcuate scotoma is
formed above or below
horizontal meridian
simultaneously then a
ring scotoma may be
formed.
formed
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Sometimes at an early
stage and sometimes only
late in the disease defects
appear in the peripheral
field.
The upper nasal field
particularly shows a
sectorial defect having a
sharply defined horizontal
edge, called Roennes
nasal step.
In later stages there is
more generalised
contraction of fields and
eventually only temporal
inland a paracentral patch
of the temporal field
persists, central vision
being abolished.
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Automated perimetry
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Diagnosis
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OCT
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Treatment:
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Medical treatment
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Filtering procedures
GUARDED:
trabeculectomy
Subscleral trephine
Subsclero thermal sclerostomy
FULL THICKNESS:
Schies
Trephines
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WOUND MODULATION
Can be done in intractable cases of
Glaucoma
Trabeculectomy with Mitomycin C
5FU
LASER PROCEDURES
helps in chronic simple glaucoma
Laser trabeculolasty
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Laser trabeculolasty
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TRABECULECTOMY
Isolated trabeculectomy
Combined with cataract extractionPhacotrabeculectomy
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Phacotrabeculectomy
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Seton in filtration
glaucoma
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BUPHTHALMOS OR
CONGENITAL
GLAUCOMA
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Clinical features
Symptoms:
(1) Epiphora
(2) Photophobia,
(3) Corneal haze or
(4) Enlargement in the size of the cornea or the
eye
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Congenital glaucoma
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Signs:
1. Blepharospasm due to corneal involvement;
2. Circumcorneal congestion may be present;
3. Cornea
enlargement in its diameter (normal 8-9 mm),
strong suspicion should arise when more than
11.5 mm, can be as large as 16-18 mm in
diameter.
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Megalocornea
Buphthalmos
Involvement
Always bilateral
Heredity
Recessive
Sex
Symptoms
No photophobic or lacrimation
Present
Cornea
Clear
IOP
Normal
Raised
Angle
Anomalous
Disc
No cupping
Size
No generalised enlargement of
eye ball
Treatment Medical /
Surgical
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Surgical
SECONDARY GLAUCOMA
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Hypertensive uveitis.
In iridocyclitis due largely to uveal engorgement and
partly to clogging of the drainage channel by the
turbid aqueous and inflammatory exudate.
Due to Sequelae of Iridocyclitis:
As a result of occlusio or secclusio pupillae there is
pupillary block leading to iris bombs and formation
of anterior peripheral synaechia which in turn leads
to raised IOP.
Essential atrophy of the iris is a degenerative
condition of obscure aetiology and is associated
with IOP.
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Tumours
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(i) Phacolytic
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(ii) Phacoanaphylactic.
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capsule)
In this condition, flake like deposits takes
Pseudoexfoliative
glaucoma
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Neovascular glaucoma
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Trauma
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Follwing Intraocular
Surgery
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Others
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THANK YOU
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