Glaucoma

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Transcript

  • 1. Glaucoma
  • 2. Glaucoma Elevated intraocular pressure (IOP) associated with optic cupping and visual field loss Enlarged optic cup in glaucoma Normal optic nerve
  • 3. Mechanism : impair outflow of aqueous resulting form
    • Abnormalities within the drainage system
    • (Open-angle glaucoma)
    • Impaired access of aqueous to the drainage system
    • (Closed-angle glaucoma)
  • 4. Physiology of aqueous humor
    • The IOP is determined by the rate of aqueous production
    • and the resistance to outflow of aqueous from the eye
    • Aqueous is produced by the ciliary body  entering the posterior
    • chamber  passes through the pupil into the anterior
    • chamber  to the trabecular meshwork in the anterior
    • chamber angle  Schlemn’s canal  venous system
  • 5. Clinical Assessment Glaucoma Tonometry : Normal range of IOP is 10-20 mmHg (AV. 15-16 ) SLE with Gonioscopy to inspect anterior angle Optic Disk Assessment by opthalmoscope Visual field examination Tonometry SLE with Gonioscopy Opthalmoscopy
  • 6. Risk factors
    • Age > 60 years
    • Family Hx of glaucoma
    • DM
    • High myopia
    • Using steroid
  • 7. Classification of glaucoma according to etiology
    • Primary glaucoma
      • 1. Open-angle glaucoma
      • 2. Angle-closure glaucoma
    • Congenital glaucoma
      • Primary congenital glaucoma
      • Associated with other developmental ocular abnormalities:
      • Aniridia, anterior chamber anomalies
      • 3. Associated with extraocular developmental abnormalities:
      • Marfan’s syndrome, Sturge-Weber syndrome,
      • Neurofibromatosis, congenital rubella
    • Secondary glaucoma
    • 1. Due to uveal tract change : uveitis, tumor
    • 2. Due to lens change : dislocation, Phacolytic
    • 3. Iridocorneal endothelial (ICE) syndrome
    • 4. Trauma : hyphema, Angle contusion, peripheral anterior
    • synechiae
    • 5. Postoperative : peripheral anterior synehiae, ciliary block,
    • following RD surgery
    • 6. Neovascular glaucoma : DM, CRVO, intraocular tumor
  • 8. Syndrome of glaucoma
    • Blurred vision
    • Headache
    • Rainbow haloes around lights
    • Pain around eyes after watching TV or
    • leaving a dark theatre
    • Red eyes
  • 9. Treatment of Glaucoma
    • Medical
    • 1. Suppression of aqueous production: Beta-blocker,Diamox
    • 2. Facilitation of aqueous outflow: pilocarpine
    • 3. Reduction of vitreous volume: glycerol
    • 4. Miotics, mydriatics, cycloplegies
    • Surgical : laser or surgery
    • 1. Selective laser tabeculoplasty (SLT)
    • 2. Trabeculotomy or trabeculectomy:
    • 3. Goniotomy
    • 4. Iridotomy or Iridectomy
    • 5. Shunts and implants of sililone or polypropylene tube
    • during trabecculectomy
    • 6. Non-penerating glaucoma surgery : (NPGS) :
    • Sclerectomy,etc.
  • 10. Complication of glaucoma surgery
    • Hypotony
    • Leakage
    • Choroidal detachment
    • Cataracts
    Shunt implantation Iridotomy Trabecculectomy