2. It is the chronic, progressive optic neuropathy
caused by a group of ocular condition, which
lead to damage of optic nerve with loss of
visual function. Most common risk factor is
raised IOP.
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3. 1. mechanical change due to raised IOP:
Raised IOP
↓
Mechanical pressure to lamina cribrosa
↓
Backward displacement and compaction of laminar
plates
↓
Narrows the opening through which axon passes
↓
Damage the nerve fibre bundle
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4. 2. Vascular perfusion:
Raised IOP
↓
Mechanical pressure on lamina cribrosa
↓
Decrease capillary blood flow
↓
Decrease perfusion to the optic nerve head
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5. It includes the spectrum of condition in which
peripheral iris moves forward to block the
openings of the trabecular meshwork in an
occludable angle causing rise in intra ocular
pressure.
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7. Common in Asians and Eskimos
Uncommon in African and Caucasians
Age: 4th to 5th decade
Sex: female: male = 4: 1
First degree relative are at increased risk
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8. 1. Anatomical:
Short eye
Smaller corneal diameter
Shallow anterior chamber
Relative anterior positioning of lens-iris and
diaphragm.
2. Physiological:
Dim illumination
Emotional stress
3. Pharmacological :
Use of mydriatic drug like atropine,
tropicamide
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9. Generally bilateral though the involvement of
two eye is often asymmetrical.
Number of clinical subtypes have been
described.
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10. Shallow anterior chamber with occludable
angle (angle recess < 20’ )
No other gonioscopic abnormalities are
present.
Provocative test:
dark room test : IOP rise by 8mm Hg.
mydriatic provocative test : 2% pilocarpine
No any clinical symptoms.
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11. Shallow anterior chamber with occludable
angle (angle recess < 20’ )
IOP rise suddenly while reading in dim light,
watching the film in darkened room for short
period followed by spontaneous resolution of
pupillary block, which is possible due to
physiological myosis, which occur during
sleep.
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12. Patient complains:
Unilateral headache or brow ache.
Blurring of vision
Unbroken colored halos around light during
episodes.
Between the recurrent attacks, eyes are free
of symptoms and only sign of narrow angle
recess, clumping of pigment in angle, or
occasional peripheral anterior synechiae.
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13. It is caused by sudden occlusion of entire
angle with resultant acute rise in IOP to
extremely high level.
Patient complains:
Severe unilateral headache.
Diminution of vision in red eye.
Nausea may be frequently associated.
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14. On examination:
Corneal edema
Shallow anterior chamber
Iris bombe with vertically oval.
Mid dilated pupil.
After resolution of corneal edema,
gonioscopically closed angle can be seen i.e.
extensive irido-corneal synechiae and optic
disc may be found to be either hyperemic or
normal.
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15. It is said if IOP is chronically raised in eyes if
synechial closure over at least 180 degree.
Change in optic nerve head or visual field
may or may not be present.
Causes:
a. repeated subacute attacks of primary angle-
closure glaucoma
↓
Extensive synechial closure
↓
Chronoically elevated IOP
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16. b. acute primary angle closure glaucoma, which
persists more than few hours
↓
Irreversible synechial closure of angle and
permanent damage to trabecular meshwork.
c. asymptomatic or ‘creeping’ angle closure
↓
Synechial closure occurs within depth of angle.
↓
Progressively involves the entire angle.
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17. Acute congestive glaucoma is the emergency
condition and need to be controlled
immediately.
Management is essentially surgical.
Medical therapy is given as an emergency and
temporary measure in order to decrease IOP
before ready for operation.
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18. 1. systemic hyperosmotics to decrease IOP given
as soon as diagnosed.
i.v. Mannitol (1gm/kg body wt)
Oral glycerol (1.5gm/kg)
2. tab. Acetazolmide
3. Analgesics and antiemetics
4. Pilocarpine eyedrops – started after IOP is bit
lowered by hyperosmolar agents.
5. Beta-blocker – 0.5% Timolol BD
6. Corticosteroid eyedrop. E.g. dexamethasone 3-
4times/day to reduce inflammation.
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19. 1. Peripheral laser iridotomy:
Indications:
Peripheral anterior synechiae: <50% of angle
Prophylactic
Bypass pupillary block
A hole is made in peripheral iris allowing the
aqueous to drain directly from posterior
chamber to region of trabecular meshwork.
Laser iridotomy : non invasive method
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21. 2. Trabeculectomy (filtration surgery)
Indication:
IOP not controlled within 12 hours of
vigorous medical therapy
Peripheral anterior synechiae: >50% of angle
It provides an alternative to angle of drainage
of aqueous from anterior chamber into
subconjunctival space.
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23. 1. All of following anatomical change
predispose to primary angle closure
glaucoma expect?
a. Small cornea
b. Flat cornea
c. Shallow anterior chamber
d. Short axial length of eyeball
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24. 2. All are the feature of acute attack of primary
narrow angle glaucoma expect?
a. IOP raised up to 40-70mm Hg
b. Eye red, painful, and tender
c. Disc shows glaucomatous cupping
d. Fellow eye also shows shallow anterior
chamber
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25. 3. The most common provocative test for angle
closure glaucoma is:
a. Water drink test
b. Dark room test
c. Mydriatic-miotic test
d. Homatropine mydriatic test
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26. 1. A 55 years old patient with moderate
hypermetropia in both eyes presented in
emergency department with sudden painful
diminution of vision. O/E, her right eye was
red with high IOP and shallow anterior
chamber and her left eye also had shallow
anterior chamber.
a) What is your most likely diagnosis?
b) Write about the treatment?
c) Write briefly about the aqueous secretion
and drainage?
September 5, 2015