you can get knowledge about the glaucoma, its different types, and its pathogenesis....... how to treat it....... its possible surgeries........ how it damages the eye and causes vision defects....

2. Glaucoma and its
Classifications

3. BY
ANAM SEHREEN
DOCTOR OF OPTOMETRY

4. What is glaucoma?
o A disease of the optic nerve.
o When damage to the optic nerve
fibers occurs, blind spots develop;
o Blind spots usually go undetected
until optic nerve is significantly
damaged.
Normal vision
2
Vision as it might be
affected by glaucoma

6. Glaucoma
o Pathophysiology of glaucoma revolves around the
aqueous humour dynamics.
o The principal ocular structures concerned with it
are:
 Ciliary body: A seat of aqueous production
 Angle of anterior chamber: It plays an important
role in the process of aqueous drainage.
 Aqueous outflow system: It includes the trabecular
meshwork, Schlemm’s canal, collector channels,
aqueous veins and the episcleral veins

7. Glaucoma

8. Secretion of aqueous humour
Ciliary body (posterior chamber)
Route of Drainage
 Trabecular outflow (90%)
 Uveal-scleral outflow (10%)
Aqueous production and drainage

9. Trabecular Outflow

10. Uveoscleral Outflow

11. Types of glaucoma
Classification according to etiology
* Primary glaucoma
* Secondary glaucoma
* Congenital
- Primary congenital
- Infantile: present in first year of life
- Juvenile: present in late childhood

12. Types of glaucoma
Classification according to appearance of the
angle mechanisms cause impaired aqueous
outflow
* Open angle glaucoma
* Closed angle glaucoma

15. Types of Glaucoma
Normal-Tension Glaucoma

16. Congenital Glaucoma

17. Description
 A rare condition
 Manifests without associated anomalies
Pathogenesis
 Maldevelopment of the angle structures
 Impaired aqueous outflow
 Raised IOP
CONGENITAL GLAUCOMA

18. Pathogenesis
o Primary congenital glaucoma is due to failure
or abnormal development of the trabecular
meshwork
o Maldevelopment of the trabeculum including
iridotrabecular junction (trabeculo-dysgenesis)
which is responsible for impaired aqueous
outflow resulting in raised IOP.
Primary congenital glaucoma

19. o Trabeculo-dysgenesis is characterized by
absence of the angle recess with iris having a
flat or concave direct insertion into the
surface.
o The iris may not completely separate from
the cornea that the angle remains closed by
persistent embryonic tissue.
Pathogenesis

20. Etiology
10% show autosomal recessive inheritance with
variable penetration
Prevalence and genetic pattern
 10% cases exhibit an autosomal recessive
inheritance.
 Sex linkage is not common in inheritance,
over 65% of the patients are boys.
 The disease affects only 1 child in 10,000
births.

21. True congenital glaucoma (40%)
IOP becomes elevated intrauterine life and child
is born with ocular enlargement.
Infantile glaucoma (50%)
It manifests prior to child’s third birthday.
Juvenile glaucoma (10%)
It manifests between 3-16 years.
Congenital glaucoma classification

22. Symptoms
 Photophobia
 Lacrimation
 Blepharospasm
 Enlarged eyeball
 Eye rubbing
Clinical Features

23.  Corneal signs: Corneal oedema, Descemet’s
breaks, and corneal enlargement more than
13mm diameter
 Sclera become thin and appears blue due to
underlying uveal tissue.
 Iris may show iridodonesis (vibration of iris
with eye movement) and atrophic patches in
late stage
Clinical Features

24.  Lens becomes flat due to stretching of
zonules and may even subluxated.
 Optic disc shows increased cup/disc ratio and
atrophy specially after third year.
 IOP is invariably high.
Clinical Features

25. ASSESSMENT
o Child may need an examination under the
anesthesia
o History on lacrimation, photophobia, and
blepharospasm
o Assess visual acuity and perform refraction to
find out loss of vision
o Examine cornea for edema and opacity

26. o Measure IOP with hand held Perkin’s
applanation tonometer
o Measure corneal diameter.
o Perform a dilated fundus examination to
evaluate the optic disc and retina.
ASSESSMENT

27. Altered visual perception secondary to
increased IOP and manifested as profound
lacrimation, photophobia, corneal haze, and
buphthalmos and loss of vision
DIAGNOSIS

28. o IOP will be controlled and bring down to
normal.
o Lacrimation will be controlled.
o Photophobia and corneal haze will be
eliminated.
o Prevent eye from loss of vision.
EXPECTED OUTCOME

29. o Counsel the child’s parents for urgent need
of surgery
o Prepare them psychologically
o Check the ophthalmologic order of the
management plan
o Topical beta-blocker (timolol 0.25% to 0.50%
b.i.d.).
Intervention

30. Goniotomy
It is the first choice of surgery (Clear cornea)
Trabeculotomy
 Corneal clouding prevents visualization of the
angle
 Failed repeated goniotomy
Monitor IOP, optic disc, and corneal diameter on
regular follow up .
Intervention

31. GONIOTOMY
TRABECULOTOMY
MANAGEMENT OF CONGENITAL
GLAUCOMA

32. Outcome criteria
Cornea should be transparent and IOP should
be maintained with in normal range
EVALUATION