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Normal tension glaucoma ntg

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Ameerhamza S B
7th term
SIMS , Shimoga

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Normal tension glaucoma /
low tension glaucoma
 Typical glaucomatous disk changes
and visual field defects
 Intraocular ...

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Chronic low vascular perfusion  makes
optic nerve susceptible for normal IOP
This view is supported by
- Raynaud phenomen...

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Normal tension glaucoma
Normal tension glaucoma
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Normal tension glaucoma ntg

  1. 1. Ameerhamza S B 7th term SIMS , Shimoga
  2. 2. Normal tension glaucoma / low tension glaucoma  Typical glaucomatous disk changes and visual field defects  Intraocular pressure constantly below 21mmHg  The angle of the anterior chamber is open on gonioscopy  No secondary cause for glaucomatous disk changes
  3. 3. Chronic low vascular perfusion  makes optic nerve susceptible for normal IOP This view is supported by - Raynaud phenomenon - Migraine - Nocturnal systemic hypotension and overtreated hypertension - Reduced blood flow velocity in Ophthalmic A.
  4. 4. IOP : consistently lower than 21mmHg Optic disc changes : Are similar to POAG with following special features - Thinning of neuroretinal rim - Flame shaped haemorrhages of the optic nerve rim (Drance haemorrhage) - Deep, focal notching of the rim - Peripapillary atrophy
  5. 5. Visual Field Defects : Similar to POAG but more deeper,steeper,more localised and closure to fixation point
  6. 6. DD’s High pressure glaucomas POAG Glaucoma with intermittent rise in IOP Previous episodes of Glaucoma Non glaucomatous optic neuropathies Congenital optic disc anomalies Acquired optic neuropathies
  7. 7. 1. Medical Treatment to lower IOP “Aim is to lower IOP by 30% i.e. to about 12- 14mmHg” Betaxolol is DOC because it also increases optic nerve blood flow Drugs with neuroprotective effect like Brimonidine may be preferred PG analogues e.g. latanoprost have greater ocular hypotensive effect in eyes with normal IOP
  8. 8. 2.Trabeculectomy: When there is progressive field loss occurs despite IOP in lower teens 3.Systemic calcium channel blockers : (e.g.nifedipine) in patients with confirmed peripheral vasospasm
  9. 9. REFERNCE - Comprehensive OPTHALMOLOGY 6th Edition by A.K.KHURANA

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