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Definition

Glaucoma is an optic neuropathy characterized by

optic disk cupping and irreversible visual field loss.

It is the second causing blindness eye disease and the

total of 10% among the blindness

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DEMOGRAPHIC
•Age
•Gender
•Race
OCULAR
•Intraocular pressure
•Optic nerve head
•Myopia
•Hypermetropia
SYSTEMIC
•Diabetes
•Systemic hypertension
GENETIC
•Family history
OTHER
•Cigarette smoking
•Alcohol intake
•Socioeconomic factors

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Trabecular system Uveoscleral system
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The theory of mechanical

The theory of blood vessel ischemia

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 10-21mmHg (1mmHg=0.133Kpa)
Normal range of the IOP
diurnal variation<8mmHg within 24hr.

Inter-eye difference <5mmHg

“Normal tension glaucoma”: IOP＜20mmHg

“Ocular hypertension”: IOP＞30mmHg

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IOP

Anterior chamber

Visusal field

Optic disc

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※Primary glaucoma
－Primary angle closure glaucoma (PACG）
－Primary open angle glaucoma (POAG)

※Secondary glaucoma

※Congenital glaucoma
－Infants
－Juvenile

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• Poor drainage is caused
because the angle between
the iris and the cornea is too
narrow and is physically
blocked by the iris. This
condition leads to a sudden
build up of pressure in the
eye.
• Angle closure glaucoma with
pupillary block leading to
peripheral iris obstruction of
the trabecular meshwork
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• Risk factors
1. Age (>50 year old)
Risk increases with increasing age
2. Race
More common in blacks
3. Gender(Female)
4. Refractive error(Myopes are more predisposed)
5. Family history

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 Anatomical predisposed eyes
－Short axial length,small cornea,shallow anterior
chamber,anterior chamber,narrow angle,thicker,anterioly
placed lens.
－Peripheral iris bombe
－Pupillary block

Precipitating factors
◎Dim illumination

◎Emotional stess

◎Drugs(anticholenergics,adrenergics,s
ystemic drugs)
Acute angle closure glaucoma
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 Disease Stating
Presymptomatic stage

Symptomatic Acute attack intermittent stage chronic stage

stage
Subacute attack

Absolute stage

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Acute onset sequela:
￭Visual acuity get better
￭KP
￭Iris:atrophy,pigmentation defects and limited sticky
￭The pupil can't return to normal
￭Cloudy-glaucoma spot on the anterior lens capsule
￭Anterior chamber Angle extensive stick

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※intermittent stage :
symptoms to ease and anterior chamber angle open.

※Chronic stage:
anterior chamber angle extensive stick

※Absolute stage:
the continuous high intraocular pressure, poor
eyesight or no light feeling.

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￭No symptom at the early age
￭IOP elevation,increased IOP fluctuation
￭Open anterior chamber angle
￭Glaucomatous optic neuropathy
－Optic disc cupping,RNFL defect,hemorrhage
－Glaucomatous visual field loss

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Principle
－Comprehensive medical therapy
lower IOP,constict pupil,prevent peripheral
anterior synechiae,lessen inflammtory reaction.

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 Medical therapy

￭Increase aqueous outflow

－Miotic:Pilocarpine
￭Dcrease aqueous production
－Beta-blockers:Timolol
－Alpha2-agonists:Brimonidine
－Carbonic anhydrase inhibitors:Acetazolamide
￭Decrease vitrous volume
－Hyperosmotics:Mannitol

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 Surgical management

￭Relieve pupillary block

－Laser iridotomy
－Incisional peripheral iridotomy

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￭Filtering suergery (surgery to improve the rate of aqueous
outflow)
－Trabeculectomy

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￭Cyclodestructive surgery (surgery to reduce the rate
of aqueous production)
－Cyclophotocoagulation
－Cyclocryotherapy

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Traumatic glaucoma

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Cataract expansion glaucoma

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Neovascular glaucoma

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※Infantile glaucoma:
Photophobia, Tears, Corneal increases and cloudy,
anterior chamber deepened.IOP Increased and
physiological concave expand.
※Juvenile glaucoma
※Others

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 Reviews

1. Definition?
2. Types of glaucoma?
3. Normal range of IOP?
4. Treatments: medication, surgery.
5. Symptoms and signs of PACG?

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