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Glaucoma

Dr Roopa Rokhade

Glaucoma
A multifactorial
progressive optic
neuropathy with
characteristic loss of
optic nerve fibres or
visual field changes.
Commonest cause of
irreversible blindness in
the world

Classification

1 Defined by absence or presence of causative factors:


primary or secondary.
2 Defined by the anatomy of the drainage angle: open
angle or angle closure.
3 Defined by speed of onset: acute or chronic.
4 Defined by age of onset: congenital, juvenile or
adult.
5 Defined by level of IOP: normal tension glaucoma
(characteristic glaucomatous optic neuropathy with IOP
in the normal range) or ocular hypertension (IOP
above the normal range but no glaucomatous optic
neuropathy).

Primary open angle


glaucoma

Commonest form of glaucoma in


Caucasian and Afro-Caribbean populations.
The exact mechanism of pathogenesis is
unknown, but various factors are
implicated including elevated IOP and
altered vascular supply to the optic nerve.
Genetics - nine loci in the human genome ;
Risk factors include elevated IOP, family
history, DM, Myopia and Afro-Caribbean
descent.

Symptoms: Usually asymptomatic / Tunnel


vision is not noticed early on.

Signs
1. Usually raised IOP >21 mmHg.
2. Normal open angle on gonioscopy.
3. Optic disc changes:gradual thinning of the
neurosensory rim (ISNT) , nerve fibre layer
defect, optic disc rim notching and cupping,
cup: disc ratio enlarged and/or asymmetrical.
4. Visual field : characteristic arcuate scotoma

Treatment
1. Medical with daily or twice
daily topical drops to reduce
the intraocular pressure
2. laser and surgical options
(Trabeculectomy).
Most patients are
maintained on regular topical
medication with monitoring of
disc appearance and visual
field analysis

Acute angle-closure glaucoma (AACG)


Commoner in older, hypermetropic people.
Commonest glaucoma in Chinese people.
Symptoms
1. Sudden onset of severely painful red eye.
2. Blurred vision.
3. Halos around lights.
4. Headache.
5 Nausea and vomiting.

Treatment: emergency
1. Treat medically (topical and
systemic) to bring down IOP
and break attack.
2. Prevent further attacks with
YAG laser iridotomy or
surgical peripheral
iridectomy (in both eyes).
3. The second eye is treated
prophylactically to prevent
later

Chronic angle-closure glaucoma Younger age group with intermittent


angle-closure symptoms.
Treatment - Laser peripheral iridotomy.
Secondary glaucoma- Multiple causes
including uveitis, rubeosis, drugs and
trauma.
Treatment- Treat the cause and control IOP

Congenital glaucoma / infantile glaucoma / buphthalmos

Occurs in infancy, and can be unilateral or bilateral.


Primary or associated with ocular malformation or systemic
syndrome, e.g. SturgeWeber. Can go blind if not detected and
treated.
Symptoms
Watering photophobic eyes.
Signs
1. Large eyes (myopic)buphthalmos.
2. Diameter of corneas wider than normal.
3. Reduced vision.
4. Clouding of corneas.
5. Linear tears in Descemets membrane.
6. Raised IOP.
7. Red eyes.

Treatment
Specialist medical
management by paediatric
ophthalmologist.
Then various surgeries,
goniotomy, trabeculotomy
or trabeculectomy.
Goniotomy is the first
choice and may have to be
repeated