ACUTE GLAUCOMA

M. SALEH TUALEKA
PENGERTIAN
Kondisi peningkatan TIO secara tiba-tiba dan
disertai penurunan fungsi visual akibat
proses kongesti pd mata.

Terdapat 2 type :
- PRIMARY (UNKNOWN CAUSED)
- SECONDARY (HYPHAEMIA, LENS DISLO-
CATION, DM, ETC.)
AQUEOUS HUMOUR
PRODUCTION
ACTIVE SECRETION FROM NON-PIGMENTED EPITHELLIUM OF THE
CILIARY BODY AS RESULT OF A METABOLIC PROCESS ( Na+/K+
ATPase PUMP, CARBONIC ANHYDRASE)
OUTFLOW
TRABECULAR MESHWORK :
- UVEAL MESHWORK
- CORNEOSCLERAL MESHWORK
- ENDOTHELIAL (JUXTACANALICULAR) MESHWORK
SCHLEMM CANAL, CONNECT IN/DIRECTLY EPISCLERAL VEINS
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 .

ACUT CONGESTIVE GLAUCOMA , PERFORM FROM

A. PRIMARY GLAUCOMA
STAGE 3 OF THE PRIMARY ANGLE CLOSURE GLAUCOMA.
= PRIMARY ANGLE-CLOSURE GLAUCOMA, 6 CLINICAL STAGES:
A. LATENT ANGLE-CLOSURE GLAUCOMA
B. SUBACUTE (INTERMITTEN) ANGLE-CLOSURE GLAUCOMA
C. ACUTE CONGESTIVE ANGLE-CLOSURE GLC
D. POSTCONGESTIVE ANGLE-CLOSURE GLAUCOMA
E. CHRONIC ANGLE-CLOSURE GLAUCOMA
F. ABSOLUTE ANGLE-CLOSURE GLAUCOMA
B. SECONDARY GLAUCOMA
1. IRIDICYCLITIS (IRIS BOMBANS) = INFLAMATORY
GLAUCOMA
2. BLUNT INJURY :
1- 12 HOURS AFTER INJURY
A. HIPHAEMIA TRAUMATIC
B. LENS DISLOCATION (TRAUMATIC)
3-5 MONTHS AFTER INJURY
A. ANGLE RECESS GLAUCOMA
B. GHOST CELL GLAUCOMA
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3. HYPERMATURE CATARACT
4. AFTER INTRAOCULER SURGERY
= RETINAL BUCKLING, SILICONE OIL
= CATARACT EXTRACTION
5. RUBEOSIS IRIDIS
= DM
= CRVO
6. INTRAOCULAR TUMORS
= RETINOBLASTOMA
= MULTIPLE MYELOMA
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1.ACUTE CONGESTIVE ANGLE-CLOSURE

GLAUCOMA (PRIMAY GLAUCOMA)
This is a sight –threatening emergency.
CLINICAL FEATURE
- Symptoms : + rapidly progressive unilateral visual loss
+ periocular pain & congestion
+ nausea & vomiting
- Slit lamp biomicroscopy
+ injection the limbal & conjunctival blood vessels
+ corneal oedema
+ peripheral iridocorneal contact
+ pupil is fixed semi-dilated, vertically oval
+ IOP is 50-100 mmHg
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- Gonioscopy, perform until the corneal oedema resolved by topical

glicerine or hypertonic saline ointment , shows complete periphe-
ral iridocorneal contact (Shaffer grade 0)
- Ophthalmoscopy, optic disc oedema & hyperaemia

IMMEDIATE TREATMENT
- Acetasolamide 500 mg/IV, 500 mg orally
-Topical therapy : + pilocarpine 2 %
+ beta blocker (timolol maleat 0,5 %)
- Glyserol 50 % (1g/Kg bw) orally or 20% mannitol IV
- Analgesia & anti-emetics
- YAG laser iridotomy : effective in relatively mild cases
-Trabeculectomy
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2. ACUT SECONDARY GLAUCOMA
 ANAMNESIS : IMPORTANT (INJURY, AFTER
OPERATION, METABOLIC DISEASES ETC)
 CLINICAL FEATURE : SYMPTOMS LIKES OF
THE ACUT PRIMARY ANGLE CLOSURE
GLAUCOMA. SIGN BY BIOMICROSCOPE CAN
BE OBSERVED THE CAUSED OF THE
GLAUCOMA AT THE ANTERIOR CHAMBER
(IRIS NEO-VASCULARISATION, HYPHAEMIA,
HYPO-PYON, LENS MATERIAL, VISCO-ELASTIC
MATERIAL ETC)
 MANAGEMENT :
.

1. IRIS BOMBANS : ATROPIN ED, STEROID,

YAG LASER IRIDOTOMY
2. HYPHAEMIA : PARACENTESIS
3. HYPERMATURE CATARACT : LENS
EXTRACTION
4. LENS DISLOCATION : LENS EXTRACTION
5. EVACUATION : LENS/ VISCO MATERIALS
6. TRABECULECTOMY/ SHUNT (AHMED
VALVE IMPLANT)
7. ENUCLEATION
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