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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 pressur...
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 compla...
Glaucoma

So can we do at least
something with it?

Patient has a good chance to
live a long happy life with a
satisfactor...
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 t...
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
t...
Glaucoma

So what is the difference
between two major types?
Open angle glaucoma is the most
common form in the European
a...
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...
Glaucoma

What are the types of
glaucoma? (2)

Chronic glaucoma is totally
unremarkable for a physician
and inconspicuous ...
Glaucoma

What are the types of
glaucoma? (2)
Acute glaucoma is the one that
should be very clearly
understood by any doct...
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 ...
Glaucoma

What are the types of
glaucoma? (4)
For the secondary type (either
open angle or angle-closure
glaucoma) - there...
Glaucoma

What are the types of
glaucoma? (4)
Secondary open angle glaucoma reasons:
phacolysis, red blood cells, hyperten...
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 (iridocycli...
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 eventua...
Glaucoma

Classification of
glaucoma

1)
2)
3)
4)

open angle / angle-closure
chronic / acute
congenital / acquired
primar...
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 blu...
Glaucoma

What are the signs of
this disease?

Any damage to optic nerve
(including glaucoma)
inevitably leads to visual
f...
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 a...
Glaucoma

What are the signs of
this disease?
The only patient with glaucoma,
who is complaining – is either the
patient w...
Glaucoma

What are the signs of
this disease?
In acute glaucoma attack:
-painful eye (+irradiation of pain)
-no discharge,...
Glaucoma

What is the diagnostics?
1)
2)
3)
4)

5)
6)

assess family history! Any blinds? Glaucoma is
inheritable!
check v...
Intraocular pressure sometimes
makes the eye “hard as a stone”.
Just touch each eyes with two fingers, palpate it.

Glauco...
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, exte...
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.
...
Glaucoma

How can we stop this
blinding condition?
We use medications (in acute
glaucomas – acetazolamide
p/o; mannitol i/...
Glaucoma

How can we stop this
blinding condition?

In case medications failed to
stabilize the process – we
move forward ...
Glaucoma

Can we stop this
blinding condition?
Unfortunately glaucoma continues
progressing even with the best
control of ...
Glaucoma

Can we stop this
blinding condition?
Unfortunately glaucoma continues
progressing even with the best
control of ...
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Glaucoma for the students and general practitioners

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Transcript of "Glaucoma for the students and general practitioners"

  1. 1. What a general practitioner should know about Glaucoma Dr. Anthony 20 Dec, 2013
  2. 2. Glaucoma What is it? Glaucoma – is a disease of optic nerve. It may have a classical sign – elevated intraocular pressure.
  3. 3. Glaucoma Why is it important for you? Glaucoma eventually leads to irreversible blindness if uncontrolled
  4. 4. Glaucoma Who has glaucoma?
  5. 5. 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.
  6. 6. 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.
  7. 7. Glaucoma What are the types of glaucoma? (1) There are two major types: -open angle glaucoma -angle-closure glaucoma
  8. 8. Anatomical basics of glaucoma Reminder of normal anatomy
  9. 9. Glaucoma What is the nature of this disease? Of many types of glaucoma – primary open angle glaucoma is the most common
  10. 10. Glaucoma What is the nature of this disease? The pathogenesis of the primary open angle glaucoma can be described like this:
  11. 11. Glaucoma The nature of the disease
  12. 12. Glaucoma Actually, the same goes for open-angle glaucoma... The nature of the disease
  13. 13. Glaucoma The simple classic explanation of the nature of the disease
  14. 14. 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.
  15. 15. 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.
  16. 16. Glaucoma Angle-closure glaucoma scheme
  17. 17. Glaucoma Classification of glaucoma 1) open angle / angle-closure
  18. 18. 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!)
  19. 19. Glaucoma What are the types of glaucoma? (2) Chronic glaucoma is totally unremarkable for a physician and inconspicuous for a patient
  20. 20. 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.
  21. 21. Glaucoma Types of glaucoma – acute glaucoma attack
  22. 22. Glaucoma Classification of glaucoma 1) open angle / angle-closure 2) chronic / acute
  23. 23. Glaucoma What are the types of glaucoma? (3) Glaucoma can be either congenital, or acquired
  24. 24. Glaucoma Congenital glaucoma - buphtalmos
  25. 25. Glaucoma Congenital glaucoma - buphtalmos
  26. 26. Glaucoma Classification of glaucoma 1) open angle / angle-closure 2) chronic / acute 3) congenital / acquired
  27. 27. Glaucoma What are the types of glaucoma? (4) Glaucoma is always either primary or secondary
  28. 28. 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.
  29. 29. 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
  30. 30. 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!)
  31. 31. Glaucoma Secondary open angle glaucoma – phacolytic
  32. 32. Glaucoma Secondary open angle glaucoma – hyphema
  33. 33. Glaucoma Secondary open angle glaucoma – bilateral sturge-weber syndrome
  34. 34. Glaucoma Secondary open angle glaucoma – pseudoexfoliation syndrome
  35. 35. Glaucoma What are the types of glaucoma? (4) Secondary angle-closure glaucoma reasons: iridocorneal synechiae (iridocyclitis), subluxation of a lens, tumors
  36. 36. Glaucoma Secondary angle-closure glaucoma – posterior synechiae of iris
  37. 37. 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
  38. 38. Glaucoma Classification of glaucoma 1) 2) 3) 4) open angle / angle-closure chronic / acute congenital / acquired primary / secondary
  39. 39. Glaucoma What are the signs of this disease? Chronic glaucoma at the beginning is clinically irrelevant
  40. 40. 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
  41. 41. Glaucoma What are the signs of this disease? Any damage to optic nerve (including glaucoma) inevitably leads to visual field defect
  42. 42. Glaucoma Visual field deterioration during the glaucoma progression
  43. 43. Glaucoma What are the signs of this disease? False! Typically patients do not notice these kinds of defects, if notice any at all!
  44. 44. 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
  45. 45. 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
  46. 46. 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
  47. 47. 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
  48. 48. Glaucoma Visual field simple confrontational test. It allows to detect very rough field defects
  49. 49. Glaucoma Ophthalmoscopy. There’s only one disc of optic nerve that is normal here.
  50. 50. 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.
  51. 51. Glaucoma Tonometry with schiotz tonometer Ophthalmoscopy. There’s only one disc of optic nerve that is normal here.
  52. 52. Glaucoma Tonometry with slit lamp Goldmann tonometer
  53. 53. Glaucoma Gonioscopy with slit lamp and four-mirror contact lens
  54. 54. 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.
  55. 55. 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)
  56. 56. Glaucoma How can we stop this blinding condition? In case medications failed to stabilize the process – we move forward to laser or surgical treatment.
  57. 57. 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.
  58. 58. 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?
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