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    Glaucoma

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    Abeer Radi
    Glaucoma is a group of eye disorders caused by increased intraocular pressure that can damage the optic nerve, and is a leading cause of blindness. The intraocular pressure is determined by a balance between aqueous humor production and outflow through drainage pathways. There are two main theories for how increased pressure damages the optic nerve - mechanical damage to nerve fibers or reduced blood flow at the nerve head. Glaucomas are classified as open or closed angle based on whether the iris blocks the drainage angle. Chronic open-angle glaucoma is usually asymptomatic initially, progresses gradually, and is treated to lower intraocular pressure through medical, laser, or surgical means like trabeculectomy. Primary angle-closure glaucoma is a medical

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    Glaucoma

    Uploaded by

    Abeer Radi
    28 views21 pages
    Glaucoma is a group of eye disorders caused by increased intraocular pressure that can damage the optic nerve, and is a leading cause of blindness. The intraocular pressure is determined by a balance between aqueous humor production and outflow through drainage pathways. There are two main theories for how increased pressure damages the optic nerve - mechanical damage to nerve fibers or reduced blood flow at the nerve head. Glaucomas are classified as open or closed angle based on whether the iris blocks the drainage angle. Chronic open-angle glaucoma is usually asymptomatic initially, progresses gradually, and is treated to lower intraocular pressure through medical, laser, or surgical means like trabeculectomy. Primary angle-closure glaucoma is a medical

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    Glaucoma is a group of eye disorders caused by increased intraocular pressure that can damage the optic nerve, and is a leading cause of blindness. The intraocular pressure is determined by a balance between aqueous humor production and outflow through drainage pathways. There are two main theories for how increased pressure damages the optic nerve - mechanical damage to nerve fibers or reduced blood flow at the nerve head. Glaucomas are classified as open or closed angle based on whether the iris blocks the drainage angle. Chronic open-angle glaucoma is usually asymptomatic initially, progresses gradually, and is treated to lower intraocular pressure through medical, laser, or surgical means like trabeculectomy. Primary angle-closure glaucoma is a medical

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    28 views21 pages

    Glaucoma

    Uploaded by

    Abeer Radi
    Glaucoma is a group of eye disorders caused by increased intraocular pressure that can damage the optic nerve, and is a leading cause of blindness. The intraocular pressure is determined by a balance between aqueous humor production and outflow through drainage pathways. There are two main theories for how increased pressure damages the optic nerve - mechanical damage to nerve fibers or reduced blood flow at the nerve head. Glaucomas are classified as open or closed angle based on whether the iris blocks the drainage angle. Chronic open-angle glaucoma is usually asymptomatic initially, progresses gradually, and is treated to lower intraocular pressure through medical, laser, or surgical means like trabeculectomy. Primary angle-closure glaucoma is a medical

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 21

    Glaucoma

    Introduction
    ● The glaucomas are a group of eye disorders
    ○ Intraocular HTN → damage of the optic nerve

    ● Glaucoma: 2nd-leading cause of permanent blindness worldwide.


    Pathophysiology
    ● The intraocular pressure level is determined by a balance between
    production and removal of aqueous humor.

    ● What is aqueous humor?

    ● What is the pathway/s of aqueous humor outflow??


    Two theories that explain the optic nerve damage:
    1. Raised intraocular pressure causes mechanical damage to the axons.

    2. Raised intraocular pressure causes ischaemia of the nerve axons by


    reducing blood flow at the nerve head.
    Classification of primary glaucomas:
    Classification of the primary glaucomas is based on whether or not the
    peripheral iris is:

    1. clear of the trabecular meshwork ( open angle glaucoma).

    2. covering the meshwork ( closed angle glaucoma).


    Which angle are we
    talking about?
    Chronic open-angle glaucoma
    History
    1. Initially asymptomatic
    2. Gradual (slow-rising IOP)
    3. Often bilateral
    4. Progressive visual field loss.
    Signs
    1. A white eye and clear cornea.
    2. Raised intraocular pressure.
    3. Visual field defect.
    4. Cupped optic disc on fundoscopy.
    Treatment
    ● Treatment is aimed at reducing intraocular pressure.

    Three modalities of treatment are available:


    ● medical treatment.
    ● laser treatment.
    ● surgical treatment.
    Surgical Treatment
    ● Drainage surgery ( trabeculectomy)
    ● Complications
    ○ shallowing of the anterior chamber in the immediate postoperative period.

    ○ risking damage to the lens and cornea.

    ○ intraocular infection.

    ○ possibly accelerated cataract development.

    ○ failure to reduce intraocular pressure adequately.

    ○ an excessively low pressure (hypotony) which may cause macular oedema


    Primary angle-closure glaucoma
    History
    1. Sudden obstruction of the iridocorneal angle.
    2. Unilateral.
    3. Red, severely painful eye.
    4. Photophobia.
    5. Watering of the eye.
    6. Vision loss.

    7. seeing coloured rainbows around lights.


    Examination
    1. visual acuity is reduced.

    2. Red eye.

    3. cloudy cornea.

    4. oval pupil, fixed and dilated.


    Treatment
    ● Medical emergency!!

    ● Acetazolamide is administered intravenously and subsequently orally,


    together with topical pilocarpine and beta - blockers.
    Congenital glaucoma
    ● It may present at birth or within the first year.

    ● Symptoms and signs include:

    1. excessive tearing, photophobia and blepharospasm

    2. an increased corneal diameter and enlargement of the globe (buphthalmos),

    resulting in progressive myopia.

    3. a cloudy cornea due to epithelial and stromal oedema.

    4. splits in Descemet’s membrane.


    Treatment
    ● Congenital glaucoma is usually treated surgically.

    ● An incision is made into the trabecular meshwork (goniotomy) to increase


    aqueous drainage, or a direct passage between Schlemm’s canal and the
    anterior chamber is created (trabeculotomy).
    THANK YOU

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