Glaucoma

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Glaucoma

  1. 1. Glaucoma
  2. 2. Glaucoma Elevated intraocular pressure (IOP) associated with optic cupping and visual field loss Enlarged optic cup in glaucoma Normal optic nerve
  3. 3. Mechanism : impair outflow of aqueous resulting form <ul><li>Abnormalities within the drainage system </li></ul><ul><li>(Open-angle glaucoma) </li></ul><ul><li>Impaired access of aqueous to the drainage system </li></ul><ul><li>(Closed-angle glaucoma) </li></ul>
  4. 4. Physiology of aqueous humor <ul><li>The IOP is determined by the rate of aqueous production </li></ul><ul><li>and the resistance to outflow of aqueous from the eye </li></ul><ul><li>Aqueous is produced by the ciliary body  entering the posterior </li></ul><ul><li>chamber  passes through the pupil into the anterior </li></ul><ul><li>chamber  to the trabecular meshwork in the anterior </li></ul><ul><li>chamber angle  Schlemn’s canal  venous system </li></ul>
  5. 5. Clinical Assessment Glaucoma Tonometry : Normal range of IOP is 10-20 mmHg (AV. 15-16 ) SLE with Gonioscopy to inspect anterior angle Optic Disk Assessment by opthalmoscope Visual field examination Tonometry SLE with Gonioscopy Opthalmoscopy
  6. 6. Risk factors <ul><li>Age > 60 years </li></ul><ul><li>Family Hx of glaucoma </li></ul><ul><li>DM </li></ul><ul><li>High myopia </li></ul><ul><li>Using steroid </li></ul>
  7. 7. Classification of glaucoma according to etiology <ul><li>Primary glaucoma </li></ul><ul><ul><li>1. Open-angle glaucoma </li></ul></ul><ul><ul><li>2. Angle-closure glaucoma </li></ul></ul><ul><li>Congenital glaucoma </li></ul><ul><ul><li>Primary congenital glaucoma </li></ul></ul><ul><ul><li>Associated with other developmental ocular abnormalities: </li></ul></ul><ul><ul><li>Aniridia, anterior chamber anomalies </li></ul></ul><ul><ul><li>3. Associated with extraocular developmental abnormalities: </li></ul></ul><ul><ul><li>Marfan’s syndrome, Sturge-Weber syndrome, </li></ul></ul><ul><ul><li>Neurofibromatosis, congenital rubella </li></ul></ul><ul><li>Secondary glaucoma </li></ul><ul><li>1. Due to uveal tract change : uveitis, tumor </li></ul><ul><li>2. Due to lens change : dislocation, Phacolytic </li></ul><ul><li>3. Iridocorneal endothelial (ICE) syndrome </li></ul><ul><li>4. Trauma : hyphema, Angle contusion, peripheral anterior </li></ul><ul><li>synechiae </li></ul><ul><li>5. Postoperative : peripheral anterior synehiae, ciliary block, </li></ul><ul><li>following RD surgery </li></ul><ul><li>6. Neovascular glaucoma : DM, CRVO, intraocular tumor </li></ul>
  8. 8. Syndrome of glaucoma <ul><li>Blurred vision </li></ul><ul><li>Headache </li></ul><ul><li>Rainbow haloes around lights </li></ul><ul><li>Pain around eyes after watching TV or </li></ul><ul><li>leaving a dark theatre </li></ul><ul><li>Red eyes </li></ul>
  9. 9. Treatment of Glaucoma <ul><li>Medical </li></ul><ul><li>1. Suppression of aqueous production: Beta-blocker,Diamox </li></ul><ul><li>2. Facilitation of aqueous outflow: pilocarpine </li></ul><ul><li>3. Reduction of vitreous volume: glycerol </li></ul><ul><li>4. Miotics, mydriatics, cycloplegies </li></ul><ul><li>Surgical : laser or surgery </li></ul><ul><li>1. Selective laser tabeculoplasty (SLT) </li></ul><ul><li>2. Trabeculotomy or trabeculectomy: </li></ul><ul><li>3. Goniotomy </li></ul><ul><li>4. Iridotomy or Iridectomy </li></ul><ul><li>5. Shunts and implants of sililone or polypropylene tube </li></ul><ul><li> during trabecculectomy </li></ul><ul><li>6. Non-penerating glaucoma surgery : (NPGS) : </li></ul><ul><li> Sclerectomy,etc. </li></ul>
  10. 10. Complication of glaucoma surgery <ul><li>Hypotony </li></ul><ul><li>Leakage </li></ul><ul><li>Choroidal detachment </li></ul><ul><li>Cataracts </li></ul>Shunt implantation Iridotomy Trabecculectomy

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