2. Learning Aims
To learn :
Definition of Glaucoma
Secretion and drainage of aqueous humor , and control
of intraocular pressure (IOP)
Classification of glaucomas
Optic nerve head changes in glaucoma
Investigations of a case of glaucoma
3. Definition
Glaucoma represents a group of diseases defined by a
characteristic optic neuropathy that is consistent with
excavation and undermining of the neural and
connective tissue elements of the optic disc and by
eventual development of distinctive patterns of visual
dysfunction.
Although elevated intraocular pressure (IOP) is one of
the primary risk factors, its presence or absence does
not have a role in the definition of the disease.
4. Intraocular pressure(IOP)
Normal IOP : 10-22 mm Hg (mean 16 mm Hg , SD 3)
> 22mm Hg is considered abnormal.
No clear line exists between safe and unsafe IOP.
7. Aqueous humor
Secretion depends on:
Integrity of blood aqueous barrier
Blood flow to ciliary body
Neurohormonal regulation of blood and ciliary body
8. Composition of aqueous humor
Essentially protein free
Excess of H+, Cl-
ion, ascorbate , and deficit in HCo3
Others: growth factor, enzymes, prostaglandins,
steroid hormones.
Rate:2.0 µl/min
Carries metabolic substrate to , and waste from,
cornea and lens.
14. Factors affecting IOP
Rate of aqueous production
Resistance to aqueous outflow
Pretrabecular , trabecular and post trabecular
Level of episcleral venous pressure
15. Factors influencing IOP
Time of the day
Heartbeat
Respiration
Exercise
Fluid intake
Systemic medication
Topical drugs
22. Visual field analysis
Visual field analysis gives a record of the individual’s
visual field.
Types: static/ kinetic, manual/automated,etc.
It records impairment/loss of visual function and
helps in identifying any deterioration.
It is an essential part of follow-up of the glaucoma
patients.
23.
24. Gonioscopy
Gonioscopy is the clinical method to visualise the
corneoscleral angle and descibe it as opne, closed,
occludable,etc.
Methods: Direct/ indirect
Gonioscopy is done at slit lamp with a gonioscopic
mirror.
27. Shaffer grading of angle width
• Ciliary body easily visible
Grade 4 (35-45 )
• At least scleral spur visible
Grade 2 (20 )
Grade 3 (25-35 )
Grade 1 (10 )
• Only trabeculum visible
• Only Schwalbe line and perhaps
top of trabeculum visible
• High risk of angle closure
• Iridocorneal contact present
• Apex of corneal wedge not visible
• Angle closure possible but unlikely
• Use indentation gonioscopy
3 2 1
04
Grade 0 (0 )
28. Classification of Glaucomas
• Open-angle glaucoma : POAG, NTG,JOAG, glaucoma
suspect, SOAG
• Angle-closure glaucoma: PACG,ACG,Sub acute ACG,
Chronic AC, SAC with/ without pupillary block, Plateau
iris
Childhood glaucoma : Primary congenital/ infantile
glaucoma, glaucoma associated with congenital anomalies,
Secondary glaucoma in infant and children.
29. Points to remember
Definition of glaucoma
Aqueous humor production and its drainage
Diagnosis, and investigation of glaucoma