ophthalology

1. ACUTE INTRA OCULAR PRESSURE RISE BY DR/MOHAMED ABDEL-AZIZD SUPERVISOR PROF.DR/KHALED HANAFY

2. Increased eye pressure can lead to optic nerve damage and vision loss. this can happen immediately or gradually depending on the level of eye pressure.

4. pigmentary glaucoma . A – gonioscopy revealing pigment accumulation in the trabecular meshwork B – UBM showing iris concavity; C – Iris transillumination defects; D – Krukenberg's spindle

5. Retrobulbar hemorrhage due to trauma

8. Advanced anterior segment neovascularization with ectropion uveae Neovascular Glaucoma choroidal detachment B - scan

9. ciliary body melanoma : ( A ) EOE is noted superonasally, with an associated sentinel vessel . ( B ) coloured photograph shows the ciliary body melanoma superonasally . ( C ) UBM demonstrating the ciliary body mass with a small area of scleral thickening corresponding to the EOE . ( D ) B - scan ultrasound with a dome - shaped mass corresponding to the melanoma .

10. Features of this syndrome: _Recurrent episodes of mild cyclitis _Uniocular involvement _Duration of attack varying from a few hours to several weeks _Corneal edema with a few keratic precipitates. _Normal IOP between episodes _IOP usually is elevated (40-60 mm Hg) _IOP is related to the duration of uveitis but NOT to the degree of uveitis Glaucomato cyclitic crisis

11. PSS:Fine kps,white eye and increase IOP

13. _The acute rise in intraocular pressure ( IOP ) is related to red blood cells and their byproducts clogging the trabecular meshwork. _Glaucoma is more likely to develop with total hyphema or after rebleeding Red cell glaucoma hyphema from blunt trauma

16. Signs of phacomorphic glaucoma include the following: _High intraocular pressure ( IOP ) - Greater than 35 mm Hg _Mid-dilated, sluggish, irregular pupil _Corneal edema _Injection of conjunctival and episcleral vessels _Shallow central anterior chamber ( AC) _Lens enlargement and forward displacement _Unequal cataract formation between the 2 eyes

17. Medical Care _Medical treatment of phacomorphic glaucoma is aimed at rapidly reducing the IOP to prevent further damage to the optic nerve, to clear the cornea, and to prevent synechiae formation. _ Initial management should address the acute nature of the angle closure and include beta-blockers, alpha 2-adrenergic agonists, and carbonic anhydrase inhibitors. _Miotics can worsen the secondary angle closure attack by increasing irido-lenticular contact.

18. _Laser iridectomy sometimes relieves the acute angle-closure attack, but the AC remains shallow. _ These eyes are susceptible to repeated attacks of angle closure; therefore, cataract extraction should be performed if the AC does not deepen after laser iridectomy. Secondary management _begins with laser iridotomy to relieve the pupillary block.

19. N:B. On initial puncture of the capsule on an intumescent lens, an increased risk of a tear extending to the equator exists. One method for dealing with this possibility is using a needle on a syringe to aspirate the liquefied cortex as the capsule is punctured. N:B. Because of the increased risk of complications during cataract extraction, deepening of the AC with pars plana vitreous tap has been suggested (Dada et al.,2007).

20. Acute angle closure is defined as at least 2 of the following symptoms : ocular pain, nausea / vomiting, and a history of intermittent blurring of vision with halos; and at least 3 of the following signs : IOP greater than 21 mm Hg, conjunctival injection, corneal epithelial edema, mid - dilated non reactive pupil, and shallower chamber in the presence of occlusion. predispose individuals to AACG . These include shallower anterior chambers, thinner ciliary bodies, a thinner iris, anteriorly situated thicker lens and a shorter axial eye length. A narrow angle has the most devastating consequences.

21. Abnormal forward bowing Iris characteristic of acute angle closure glaucoma Acute Angle Closure Glaucoma : External Appearance

22. Emergency Care _The treatment of acute angle - closure glaucoma ( AACG ) consists of IOP reduction, suppression of inflammation, and the reversal of angle closure . _ Once diagnosed, the initial intervention includes acetazolamide, a topical beta - blocker, and a topical steroid .

23. _Topical steroids decrease the inflammatory reaction and reduce optic nerve damage . _Addressing the extraocular manifestations of the disease is critical . This includes analgesics for pain and anti-emetics for nausea and vomiting . _ Placing the patient in the supine position may aid in comfort and reduce IOP . It is also believed that, while supine, the lens falls away from the iris decreasing pupillary block .

24. After the initial intervention, the patient should be reassessed . Reassessment includes evaluating IOP, evaluating adjunct drops, and considering the need for further intervention, such as osmotic agents and immediate iridotomy . Approximately 1 hour after beginning treatment, pilocarpine, a miotic that leads to opening of the angle, should be administered every 15 minutes for 2 doses .

25. No standard rate of reduction for IOP exists; however, Choong et el identified a satisfactory reduction as IOP less than 35 mm Hg or a reduction greater than 25% of presenting IOP . If the IOP is not reduced 30 minutes after the second dose of pilocarpine, an osmotic agent must be considered . An oral agent like glycerol can be administered in non diabetics . In diabetics, oral isosorbide is used to avoid the risk of hyperglycemia associated with glycerol .

26. Patients who are unable to tolerate oral intake or do not experience a decrease in IOP despite oral therapy are candidates for IV mannitol . _When medical therapy proves to be ineffective, corneal indentation ( CI ) can be used . any smooth instrument can be used to perform this procedure . _Laser peripheral iridotomy ( LPI ) , performed 24-48 hours after IOP is controlled, is considered the definitive treatment for AACG .

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