Glucoma

1.
Definition & Types of Glaucoma
Glaucoma is a group of eye diseases characterized by progressive optic neuropathy leading to

irreversible vision loss. The main risk factor is elevated intraocular pressure (IOP), although
normal-tension glaucoma can also occur.
 Primary Open-Angle Glaucoma (POAG): The most common form, characterized by

gradual blockage of drainage channels, leading to an increase in IOP.
 Angle-Closure Glaucoma (ACG): Caused by the closure of the anterior chamber angle,
leading to a sudden increase in IOP.
 Normal-Tension Glaucoma (NTG): Optic nerve damage occurs despite normal IOP.
 Secondary Glaucoma: Results from an underlying condition (e.g., uveitis, trauma).
 Congenital Glaucoma: A rare form that occurs in infants and children due to
developmental issues with the drainage system.
2. Epidemiology
 Prevalence: Globally, about 76 million people are affected by glaucoma.

 Risk Factors:
o Age: Higher incidence in individuals over 40 years.
o Race: More common in African, Latino, and Asian populations.
o Family History: Increased risk with positive family history.
o Medical Conditions: Hypertension, diabetes, myopia.
3. Pathophysiology
 Intraocular Pressure (IOP):

o IOP is regulated by the balance between aqueous humor production by the ciliary
body and its drainage through the trabecular meshwork and Schlemm's canal.
o Elevated IOP damages retinal ganglion cells, causing optic nerve atrophy.
o In angle-closure glaucoma, IOP rises rapidly due to sudden blockage of drainage
channels.
 Optic Nerve Damage: Loss of retinal ganglion cells leads to the characteristic "cupping"
of the optic disc, detectable on fundoscopy.
4. Clinical Features
 Primary Open-Angle Glaucoma (POAG):

o Often asymptomatic until advanced stages.
o Gradual peripheral vision loss ("tunnel vision").
o Visual acuity is preserved until late stages.
 Acute Angle-Closure Glaucoma (AACG):
o Sudden onset of severe eye pain.
o Halos around lights, blurred vision, headache, nausea, vomiting.
o Red eye, mid-dilated pupil, and hazy cornea.
o IOP is markedly elevated (>40 mmHg).
 Normal-Tension Glaucoma:
o Similar presentation to POAG, with progressive optic neuropathy, despite normal
IOP.
5. Diagnosis
 Tonometry: Measures IOP (normal range: 10-21 mmHg).

 Gonioscopy: Assesses the angle of the anterior chamber.
 Perimetry: Visual field testing to detect peripheral vision loss.
 Optical Coherence Tomography (OCT): Assesses retinal nerve fiber layer thickness
and optic nerve head changes.
 Slit-lamp Examination: To inspect the anterior chamber and corneal clarity.
 Fundoscopy: To evaluate optic disc cupping (normal cup-to-disc ratio is <0.5).
6. Treatment
Medical Therapy:
 Prostaglandin Analogues (e.g., latanoprost): First-line therapy, increase outflow of

aqueous humor.
 Beta-Blockers (e.g., timolol): Decrease aqueous humor production.
 Carbonic Anhydrase Inhibitors (e.g., acetazolamide): Reduce aqueous humor
secretion.
 Alpha Agonists (e.g., brimonidine): Decrease production and increase outflow of
aqueous humor.
Laser Therapy:
 Laser Trabeculoplasty: Opens up the trabecular meshwork to improve drainage.

 Laser Iridotomy: Creates a small hole in the iris to relieve angle closure.
Surgical Treatment:
 Trabeculectomy: Creates a new drainage pathway to lower IOP.

 Glaucoma Drainage Devices (e.g., Ahmed valve): Used in refractory cases.
 Minimally Invasive Glaucoma Surgery (MIGS): Less invasive techniques to lower
IOP (e.g., iStent).
7. Complications of Untreated Glaucoma
 Progressive Vision Loss: If untreated, leads to irreversible blindness.

 Acute Angle-Closure Crisis: A medical emergency requiring immediate intervention to
prevent permanent vision loss.
 Optic Neuropathy: Progressive optic nerve damage results in cupping and atrophy.
8. Prevention & Screening

 Regular screening, especially for at-risk individuals (age >40, family history, diabetes).
 Early detection via tonometry, perimetry, and optic nerve assessment can prevent
progression.
 Public health initiatives to raise awareness about glaucoma in high-risk populations.
9. Prognosis
 POAG: Good if diagnosed early and treated adequately; however, vision lost cannot be
regained.
 AACG: Requires urgent treatment to prevent blindness.
 NTG: May progress despite normal IOP, requiring close monitoring.
10. Key Points for MBBS Final Year Exams
 Understand the different types of glaucoma, with emphasis on POAG and AACG.
 Know the clinical features, especially distinguishing between POAG (gradual,
asymptomatic) and AACG (acute, painful).
 Focus on diagnostic tools: tonometry, gonioscopy, and perimetry.
 Be familiar with the pharmacological agents used in glaucoma management.
 Recognize the indications for laser and surgical interventions.
 Highlight the importance of early detection and screening in preventing irreversible
vision loss.

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1.

Definition & Types of Glaucoma

Glaucoma is a group of eye diseases characterized by progressive optic neuropathy leading to

 Primary Open-Angle Glaucoma (POAG): The most common form, characterized by

 Prevalence: Globally, about 76 million people are affected by glaucoma.

 Intraocular Pressure (IOP):

 Primary Open-Angle Glaucoma (POAG):

 Tonometry: Measures IOP (normal range: 10-21 mmHg).

 Prostaglandin Analogues (e.g., latanoprost): First-line therapy, increase outflow of

 Laser Trabeculoplasty: Opens up the trabecular meshwork to improve drainage.

 Trabeculectomy: Creates a new drainage pathway to lower IOP.

7. Complications of Untreated Glaucoma

 Progressive Vision Loss: If untreated, leads to irreversible blindness.

8. Prevention & Screening

10. Key Points for MBBS Final Year Exams

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