1. GlaucomaGlaucoma
Dr.Somboon PanyakornDr.Somboon Panyakorn

2. Cause of BlindnessCause of Blindness

3. It is a group of diseases in which damage to the
retinal ganglion cell caused by raised intraocular
pressure

4. AnatomyAnatomy

5. AnatomyAnatomy

6. AnatomyAnatomy

7. GLAUCOMAGLAUCOMA

8. Aqueous Humor Dynamics
 Produced by non-pigmented epitheliaProduced by non-pigmented epithelia
of pars plicataof pars plicata
 SecretionSecretion
 UltrafiltrationUltrafiltration
 DiffusionDiffusion
 Aqueous production rate - 2µL/minAqueous production rate - 2µL/min
 Facility of outflow – 0.22µL/min/mmFacility of outflow – 0.22µL/min/mm
of Hgof Hg

9. Factor Affect IOPFactor Affect IOP
 AgeAge
 RACERACE
 Family historyFamily history
 ExerciseExercise
 DrugDrug
 Refractive errorRefractive error
 InflammationInflammation
 SurgerySurgery

10. Normal IOPNormal IOP
Mean= 15.9mmHg ± 2 SD
IOP > 21 is abnormal.

11. Tonometers
Goldmann
Contact applanation
Perkins
Portable contact applanation
Pulsair 2000 (Keeler)Air-puff
Schiotz
Portable non-contact applanationNon-contact indentation
Contact indentation
Tono-Pen
portable contact applanation

12. Enlarge cuppingEnlarge cupping

13. STRUCTURE /FUNCTION EVALUATIONSTRUCTURE /FUNCTION EVALUATION

14. THE VISUAL FIELDTHE VISUAL FIELD
Humphrey automated perimetry

15. Clinical symptomClinical symptom

16. Clinical symptomClinical symptom

17. Ocular hypertensionOcular hypertension
 IOP higher than normal in the absence ofIOP higher than normal in the absence of
optic nerve damage or visual field lossoptic nerve damage or visual field loss
 10% turn to glaucoma in 5 years10% turn to glaucoma in 5 years

18. TreatmentTreatment
 Beta blocker : 0.5% timololBeta blocker : 0.5% timolol
 Alpha agonist : brimonidineAlpha agonist : brimonidine
 Carbonic anhydrase inhibitor :Carbonic anhydrase inhibitor :
dorsolamide,acetazolamidedorsolamide,acetazolamide
 Prostaglandin :Prostaglandin :
latanoprost,bimatoprost,travaprostlatanoprost,bimatoprost,travaprost

19. GLAUCOMAGLAUCOMA
Surgical treatment of glaucomaSurgical treatment of glaucoma
Argon laserArgon laser
trabeculoplastytrabeculoplasty
FiltrationFiltration
proceduresprocedures

20. GLAUCOMAGLAUCOMA
Filtration blebsFiltration blebs

21. ScreeningScreening
 Age > 40Age > 40
 Family historyFamily history
 Underlying disease DM HT CRF etcUnderlying disease DM HT CRF etc
 On medicationOn medication
 History of traumaHistory of trauma
 Sign and symptom suspected glaucomaSign and symptom suspected glaucoma

22. QuestionQuestion