Glaucoma for the students and general practitioners
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Glaucoma for the students and general practitioners

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The information I think medical students and general practitioners should know about glaucoma

The information I think medical students and general practitioners should know about glaucoma

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Glaucoma for the students and general practitioners Glaucoma for the students and general practitioners Presentation Transcript

  • What a general practitioner should know about Glaucoma Dr. Anthony 20 Dec, 2013
  • Glaucoma What is it? Glaucoma – is a disease of optic nerve. It may have a classical sign – elevated intraocular pressure.
  • Glaucoma Why is it important for you? Glaucoma eventually leads to irreversible blindness if uncontrolled
  • Glaucoma Who has glaucoma?
  • Glaucoma Why is it important for you? Glaucoma is a silent chronic bilateral sight-killer. Patient usually has NO complaints! And then he goes blind.
  • Glaucoma So can we do at least something with it? Patient has a good chance to live a long happy life with a satisfactory vision, if the disease is caught in time. Yes, you can make a difference.
  • Glaucoma What are the types of glaucoma? (1) There are two major types: -open angle glaucoma -angle-closure glaucoma
  • Anatomical basics of glaucoma Reminder of normal anatomy
  • Glaucoma What is the nature of this disease? Of many types of glaucoma – primary open angle glaucoma is the most common
  • Glaucoma What is the nature of this disease? The pathogenesis of the primary open angle glaucoma can be described like this:
  • Glaucoma The nature of the disease
  • Glaucoma Actually, the same goes for open-angle glaucoma... The nature of the disease
  • Glaucoma The simple classic explanation of the nature of the disease
  • Glaucoma So what is the difference between two major types? The level of aquous humor blockage... In angle-closure type trabecular meshwork is not available for humor. In open angle it is available, though working badly and sadly.
  • Glaucoma So what is the difference between two major types? Open angle glaucoma is the most common form in the European and African regions. Angle-closure glaucoma is characteristic for people of Asian descent.
  • Glaucoma Angle-closure glaucoma scheme
  • Glaucoma Classification of glaucoma 1) open angle / angle-closure
  • Glaucoma What are the types of glaucoma? (2) Glaucoma can be chronic (and it usually is), but also it can turn into acute (one of the biggest emergencies in Ophthalmology!)
  • Glaucoma What are the types of glaucoma? (2) Chronic glaucoma is totally unremarkable for a physician and inconspicuous for a patient
  • Glaucoma What are the types of glaucoma? (2) Acute glaucoma is the one that should be very clearly understood by any doctor. There’re fulminant forms, that lead to the blindness during several hours.
  • Glaucoma Types of glaucoma – acute glaucoma attack
  • Glaucoma Classification of glaucoma 1) open angle / angle-closure 2) chronic / acute
  • Glaucoma What are the types of glaucoma? (3) Glaucoma can be either congenital, or acquired
  • Glaucoma Congenital glaucoma - buphtalmos
  • Glaucoma Congenital glaucoma - buphtalmos
  • Glaucoma Classification of glaucoma 1) open angle / angle-closure 2) chronic / acute 3) congenital / acquired
  • Glaucoma What are the types of glaucoma? (4) Glaucoma is always either primary or secondary
  • Glaucoma What are the types of glaucoma? (4) For the primary type (either open angle or angle-closure glaucoma) - there is no pre-existing condition.
  • Glaucoma What are the types of glaucoma? (4) For the secondary type (either open angle or angle-closure glaucoma) - there is always definite pre-existing eye or orbit disease or systemic condition
  • Glaucoma What are the types of glaucoma? (4) Secondary open angle glaucoma reasons: phacolysis, red blood cells, hypertensive uveitis, pigmentary dispersion, pseudoexfoliation, neovascularization of angle, congenital conditions (iridocorneal endothelial syndrome, sturge-weber syndrome), carotid-cavernous fistula, trauma (recession of angle), medications (steroids!)
  • Glaucoma Secondary open angle glaucoma – phacolytic
  • Glaucoma Secondary open angle glaucoma – hyphema
  • Glaucoma Secondary open angle glaucoma – bilateral sturge-weber syndrome
  • Glaucoma Secondary open angle glaucoma – pseudoexfoliation syndrome
  • Glaucoma What are the types of glaucoma? (4) Secondary angle-closure glaucoma reasons: iridocorneal synechiae (iridocyclitis), subluxation of a lens, tumors
  • Glaucoma Secondary angle-closure glaucoma – posterior synechiae of iris
  • Glaucoma What are the types of glaucoma? (4) In any case of secondary glaucoma the IOP is highly elevated, and it eventually leads to irriversible optic nerve damage
  • Glaucoma Classification of glaucoma 1) 2) 3) 4) open angle / angle-closure chronic / acute congenital / acquired primary / secondary
  • Glaucoma What are the signs of this disease? Chronic glaucoma at the beginning is clinically irrelevant
  • Glaucoma What are the signs of this disease? During the development of the chronic disease patiend may start noticing blurred vision, and the gradual decrease of visual field
  • Glaucoma What are the signs of this disease? Any damage to optic nerve (including glaucoma) inevitably leads to visual field defect
  • Glaucoma Visual field deterioration during the glaucoma progression
  • Glaucoma What are the signs of this disease? False! Typically patients do not notice these kinds of defects, if notice any at all!
  • Glaucoma What are the signs of this disease? The only patient with glaucoma, who is complaining – is either the patient with advanced glaucoma (significant visual acuity decrease!) or the patient with an acute glaucoma attack
  • Glaucoma What are the signs of this disease? In acute glaucoma attack: -painful eye (+irradiation of pain) -no discharge, no pus -blurred vision -red eye -fixed dilated pupil -highly elevated IOP
  • Glaucoma What is the diagnostics? 1) 2) 3) 4) 5) 6) assess family history! Any blinds? Glaucoma is inheritable! check visual acuity check intraocular pressure (at least by palpation!) check pupillary reactions (are pupils reactive? are the reactions symmetric?) perform ophthalmoscopy (if available) perform confrontational visual field test
  • Intraocular pressure sometimes makes the eye “hard as a stone”. Just touch each eyes with two fingers, palpate it. Glaucoma Visual field deterioration during the glaucoma progression
  • Glaucoma Visual field simple confrontational test. It allows to detect very rough field defects
  • Glaucoma Ophthalmoscopy. There’s only one disc of optic nerve that is normal here.
  • Glaucoma What we do in eye clinics 1) 2) 3) 4) 5) Basic ophthalmological exam (visual acuity, intraocular pressure, external exam) Slit lamp examination of anterior and posterior segment of the eyeball (gonioscopy and ophthalmoscopy! We’re looking for angle-closure and “cupping” of the disc) In certain cases we must perform automated visual field test with computer We can perform tomography of optic nerve disc, if optic tomograph is available We make an appointment! We see if our treatment works.
  • Glaucoma Tonometry with schiotz tonometer Ophthalmoscopy. There’s only one disc of optic nerve that is normal here.
  • Glaucoma Tonometry with slit lamp Goldmann tonometer
  • Glaucoma Gonioscopy with slit lamp and four-mirror contact lens
  • Glaucoma How can we stop this blinding condition? We should lower intraocular pressure at least by 30% of initial point. This is the only measure now, that is proven to help such patients.
  • Glaucoma How can we stop this blinding condition? We use medications (in acute glaucomas – acetazolamide p/o; mannitol i/v; in chronic glaucomas – timolol and latanoprost eyedrops)
  • Glaucoma How can we stop this blinding condition? In case medications failed to stabilize the process – we move forward to laser or surgical treatment.
  • Glaucoma Can we stop this blinding condition? Unfortunately glaucoma continues progressing even with the best control of IOP. But the rate of progression is much slower with treatment. The prognosis for vision is satisfactory with treatment and poor without treatment.
  • Glaucoma Can we stop this blinding condition? Unfortunately glaucoma continues progressing even with the best control of IOP. But the rate of progression is much slower with treatment. The prognosis for vision is satisfactory with treatment and poor without treatment. Any questions?