Glaucoma

Glaucoma is one of the most common causes of

permanent blindness in the world.

One of the most fundamental aspects of glaucoma

is that it is not an isolated case of illness but a
widespread group of illnesses.

Can manifested by a broad spectrum of clinical and

histopathological findings.

Majority of glaucoma px dont have any symtoms in

the early stage of the disease.
 The elevation of IOP may be a sign of glaucoma but not all
cases will have it.

Statistically 2% of the population worldwide are suffering from

glaucoma but 3% of the people being 60 years and older.

Group at risk are:

Age Vascular diseases
Hx of eye trauma or surgery Hyperopia/Myopia
HPN/DM Other eye diseases
Use of steroids Family Hx of Glaucoma
 Definition
Glaucoma is described as any illness in which can cause
a typical glaucomatous damage with the optic nerve
head with typical changes in the visual field.
There are four factors which we need to diagnose and
monitor glaucoma.
These are:
Damage of the optic nerve
Loss of visual field
Intraocular pressure
Gonioscopy
 Damage of the Optic nerve
Typical Glaucomatous Optic Nerve Head Damage
Enlarging of the cup-disc ratio of the optic nerve. This can be
seen as a some what brighter area at the optic nerve head.
Darkening of the nerve fiber layer around the head.
Presence of disc hemorrhges.
Presence of notching.

Reason: Decrease of nerve cells and blood vessels in the papilla.

Elevated IOP or disturbances of the blood circulation may
cause cupping at the papilla.
The extent of the cupping is refered to as cup-Disc Ratio (CD)
which is the ratio of the cup to the diameter of the nerve head.
Normal and Glaucomatous
Optic Nerve Head
Anatomy of the Optic Nerve
A: Layer of nerve fibers: Is the
top layer of the retina facing the
vitreous, in this layer the nerve
fiber coat the whole retina.
B: prelaminar region of the
papilla: It is composed of nerve
fibers and astrocytes
C: Lamina cribrosa (Cribriform
area): In this segment are layers
of scleral conective tissue.
Astrocytes isolate these layers and
coat the openings which are used
by the neurons to leave the eye.
D:Retrolaminar region.
Anatomy of the papilla
 Theori of Glaucomatous Damage :
Mechanical Theory : compresion of optic nerve
Ischemic Theory : intraneural ischemia
 Classification of glaucoma :
1.Open angle glaucoma :
Primary Open Angle Glaucoma
Normal Tension Glaucoma

Juvenile Glaucoma

Suspect Glaucoma

Secondary Glaucoma
 2.Angle Closure Glaucoma
Acute Angle Closure
Subacute Angle Closure

Chronic Angle Closure

Secondary Angle Closure With Pupillary Block

Secondary Angle Closure Without Pupillary Block

 3.Childhood Glaucoma
Primary Congenital / infantile Glaucoma
Glaucoma Associated With Congenital Anomalies

Secondary Glaucoma In Infant And Children

 Risk factor of glaucoma :
Race
Age

Gender

Refraction

Genetic
 Visual Field

There is a distinction between the central (30) and the peripheral visual field.
The peripheral visual field is needed for the orientation and spans ,if you look
straight on, more than 90 to the temporal side, 70 downwards, and up to
60 at the nasal side and upwards.
To roughly determine the visual field one can make the thumbs-test

Visual Field
 Visual Field Loss
Untreated glaucomas will always lead to permanent
loss of optic nerve cells which would also result to
permanent loss of vision.

Clinical correlation is important in diagnosing and

monitoring.

Initially losses of the visual field can be scotomas

and normally have an island-like shape. Usually
involving the peripheral fields.
 Visual Field Loss
Typically bowshaped Bjerrum-scotomas are
formed.
In the advanced stage only the central and
temporal island of vision is left.
The central visual field (10) remains relatively
long intact until in the end even this area looses
its function.
Visual Field
Visual Field Loss
Visual Field Loss
 Intraocular Pressure (IOP)
The IOP is dependent to the inflow and outflow of
aquous humor in the anterior segment.
Aqueous humor is generated by filtration of blood and
is secreted from the ciliary body into the posterior
chamber.
It washes around the iris, lens and the interior side of
the cornea and the major part leaves via the
iridocorneal angle through the structures of the
trabecular meshwork and Schlemms canal.
Intraocular Pressure (IOP)
 Three factors determine IOP :
1.rate of aqueous production
2.resistance of aqueous outflow across
trabecular meshwork-canalis sclemmi
3.level of episcleral venous pressure
 Intraocular Pressure (IOP)

Majority would have 15 mm Hg.

Acceptable pressures would
range from 18 to 20 mm Hg
depending on the optic disc.

Women usually have higher IOP

compared to men.

IOP would increase as one gets

older.
 Intraocular Pressure (IOP)
Glaucoma px can have
high IOP compare to
normal individuals.

> 4 mm Hg flactuations

They can have spikes of

IOP
 Measurements of IOP

Impression
tonometry
according to
Schitz is
nowadays only
used in special
cases .
Measurements of IOP

Normally the
Goldmann
applanation
tonometry or
the non-contact
tonometry are
used.
 Reasons for elevated IOP
Excess production of aqueous humor
Outflow through the trabecular meshwork is
suboptimal or blocked.

Excess production is only in rare cases the

reason for elevated IOP, whereas variation of
the outflow facilities is quite common.
Iridocorneal Angle
The angle of the anterior chamber
is formed by the front side is the
cornea and the rear side is the iris.

The angle is hidden from frontal side by the limbus and can be
made visible only by means of gonioscopic mirrors

Viewing the angles will give us the type of glaucoma.

Open Angle Glaucoma or Close Angle Glaucoma
 Iridocorneal Angle
The iridocorneal angle can be open, narrow, or
even closed
Investigation of the Iridocorneal
Angle
Gonioscope :
This is a special contact lens
which is connected optically
and mechanically by a viscous
water-based liquid with the
cornea. A light beam can be
diverted such that the chamber
angle can be seen.
Investigation of the Iridocorneal
Angle
3-Mirror-contact lens:
With the help of this
binocular contact lens all
areas of the retina can be
investigated.
 Treatment

Topical Eye Medications

Laser

Surgery
TOPICAL EYE MEDICATION
 LASER
Peripheral laser
Iridotomy:
Angle Closure types of
glaucoma.

Laser Trabeculoplasty:
Open Angle types of
glaucoma.
 SURGERY
Trabeculectomy:
Creation of a bleb were
aqueous can flow out of
the eye.
Implants:
Devices which when
incerted in the anterior
chamber drains aqueous
out of the eye.
Thank You

Good Day!