Primary angle closure glaucoma is caused by obstruction of aqueous outflow due to closure of the anterior chamber angle. It is the leading cause of glaucoma blindness worldwide, particularly affecting Asian populations. The angle becomes occluded due to pupillary block or anatomical factors. Acute episodes involve severe eye pain and vision loss from high intraocular pressure. Chronic cases develop optic nerve damage and visual field loss over time if not treated with laser iridotomy or medication to lower pressure and open the angle. Late stage "absolute glaucoma" results in a blind, painful eye requiring aggressive interventions like cycloablation.
This document provides an overview of primary angle closure glaucoma (PACG). It defines PACG as a type of glaucoma characterized by occludable anterior chamber angles leading to increased intraocular pressure and optic nerve damage. Risk factors include older age, female sex, and Asian ethnicity. The document discusses the pathophysiology, classification, clinical presentation, diagnosis and management of both acute and chronic PACG. Laser peripheral iridotomy is an important treatment to open the angle and prevent further attacks, while medical therapy aims to lower intraocular pressure.
Dr. Ajai Agrawal's presentation defines primary angle closure glaucoma (PACG) as a type of glaucoma characterized by occludable anterior chamber angles that lead to increased intraocular pressure and optic nerve damage. The presentation covers the epidemiology, risk factors, pathogenesis, classification, diagnosis and management of PACG. Treatment may involve medical management, laser peripheral iridotomy to open the angles, or filtering surgeries in advanced cases. Regular follow up is important as PACG can progress to cause vision loss if not properly treated.
Dr. Ajai Agrawal's presentation defines primary angle closure glaucoma (PACG) as a type of glaucoma characterized by occludable anterior chamber angles that lead to increased intraocular pressure and optic nerve damage. The presentation covers the epidemiology, risk factors, pathogenesis, classification, diagnosis and management of PACG. Treatment may involve medical management, laser peripheral iridotomy to open the angle, or filtering surgeries in advanced cases. Regular follow up is important as PACG can progress to cause vision loss if not properly treated.
Glaucoma is a group of eye disorders characterized by optic nerve damage and vision loss caused by increased pressure in the eye. The document discusses the definition, epidemiology, causes, clinical features, diagnosis, and management of primary open angle glaucoma and primary angle-closure glaucoma. Key points include that glaucoma has various clinical manifestations, causes include blockage of aqueous outflow, signs involve optic nerve changes and visual field loss, and treatment aims to lower intraocular pressure through medication, laser treatment, or surgery.
This document provides information about primary open-angle glaucoma (POAG):
- It defines POAG as a chronic, progressive optic neuropathy characterized by an open anterior chamber angle and elevated intraocular pressure.
- Risk factors, clinical presentation, diagnosis, differential diagnosis, evaluation, and treatment options are discussed. Treatment may involve medications, laser trabeculoplasty, or glaucoma surgery with the goal of reducing intraocular pressure to halt optic nerve damage.
- Two case studies are presented to exemplify the evaluation and treatment of patients with POAG.
Primary angle-closure glaucoma is caused by apposition of the peripheral iris against the trabecular meshwork, obstructing aqueous outflow. It is a major cause of glaucoma blindness worldwide. Predisposing anatomical factors include a shallow anterior chamber and narrow anterior chamber angle. Precipitating factors like dim illumination or mydriatic drugs can cause a pupil block mechanism, obstructing outflow. Acute primary angle closure is a medical emergency treated with medications and laser iridotomy. Chronic primary angle closure glaucoma causes optic nerve damage and visual field loss.
Primary angle closure glaucoma is caused by apposition of the peripheral iris against the trabecular meshwork, obstructing aqueous outflow. It is a major cause of glaucoma blindness worldwide. Risk factors include older age, female sex, Southeast Asian or Chinese descent, hyperopia, anatomically narrow anterior chamber angles, and heredity. Primary angle closure can progress to primary angle closure glaucoma if untreated, causing increased intraocular pressure and optic nerve damage. Treatment options include laser peripheral iridotomy, medications, filtration surgery, and lens extraction depending on the stage and severity of the condition.
Glaucoma is an optic neuropathy characterized by cupping of the optic disc and loss of visual field. It is usually associated with increased intraocular pressure (IOP). If left untreated, glaucoma can lead to irreversible blindness. There are several types of glaucoma including open-angle glaucoma, angle-closure glaucoma, congenital glaucoma, and secondary glaucoma caused by injuries, infections, tumors or inflammation. Treatment options include medications, laser treatment, or surgery to lower IOP and prevent further vision loss. The goal is early detection and treatment to preserve sight.
This document provides an overview of primary angle closure glaucoma (PACG). It defines PACG as a type of glaucoma characterized by occludable anterior chamber angles leading to increased intraocular pressure and optic nerve damage. Risk factors include older age, female sex, and Asian ethnicity. The document discusses the pathophysiology, classification, clinical presentation, diagnosis and management of both acute and chronic PACG. Laser peripheral iridotomy is an important treatment to open the angle and prevent further attacks, while medical therapy aims to lower intraocular pressure.
Dr. Ajai Agrawal's presentation defines primary angle closure glaucoma (PACG) as a type of glaucoma characterized by occludable anterior chamber angles that lead to increased intraocular pressure and optic nerve damage. The presentation covers the epidemiology, risk factors, pathogenesis, classification, diagnosis and management of PACG. Treatment may involve medical management, laser peripheral iridotomy to open the angles, or filtering surgeries in advanced cases. Regular follow up is important as PACG can progress to cause vision loss if not properly treated.
Dr. Ajai Agrawal's presentation defines primary angle closure glaucoma (PACG) as a type of glaucoma characterized by occludable anterior chamber angles that lead to increased intraocular pressure and optic nerve damage. The presentation covers the epidemiology, risk factors, pathogenesis, classification, diagnosis and management of PACG. Treatment may involve medical management, laser peripheral iridotomy to open the angle, or filtering surgeries in advanced cases. Regular follow up is important as PACG can progress to cause vision loss if not properly treated.
Glaucoma is a group of eye disorders characterized by optic nerve damage and vision loss caused by increased pressure in the eye. The document discusses the definition, epidemiology, causes, clinical features, diagnosis, and management of primary open angle glaucoma and primary angle-closure glaucoma. Key points include that glaucoma has various clinical manifestations, causes include blockage of aqueous outflow, signs involve optic nerve changes and visual field loss, and treatment aims to lower intraocular pressure through medication, laser treatment, or surgery.
This document provides information about primary open-angle glaucoma (POAG):
- It defines POAG as a chronic, progressive optic neuropathy characterized by an open anterior chamber angle and elevated intraocular pressure.
- Risk factors, clinical presentation, diagnosis, differential diagnosis, evaluation, and treatment options are discussed. Treatment may involve medications, laser trabeculoplasty, or glaucoma surgery with the goal of reducing intraocular pressure to halt optic nerve damage.
- Two case studies are presented to exemplify the evaluation and treatment of patients with POAG.
Primary angle-closure glaucoma is caused by apposition of the peripheral iris against the trabecular meshwork, obstructing aqueous outflow. It is a major cause of glaucoma blindness worldwide. Predisposing anatomical factors include a shallow anterior chamber and narrow anterior chamber angle. Precipitating factors like dim illumination or mydriatic drugs can cause a pupil block mechanism, obstructing outflow. Acute primary angle closure is a medical emergency treated with medications and laser iridotomy. Chronic primary angle closure glaucoma causes optic nerve damage and visual field loss.
Primary angle closure glaucoma is caused by apposition of the peripheral iris against the trabecular meshwork, obstructing aqueous outflow. It is a major cause of glaucoma blindness worldwide. Risk factors include older age, female sex, Southeast Asian or Chinese descent, hyperopia, anatomically narrow anterior chamber angles, and heredity. Primary angle closure can progress to primary angle closure glaucoma if untreated, causing increased intraocular pressure and optic nerve damage. Treatment options include laser peripheral iridotomy, medications, filtration surgery, and lens extraction depending on the stage and severity of the condition.
Glaucoma is an optic neuropathy characterized by cupping of the optic disc and loss of visual field. It is usually associated with increased intraocular pressure (IOP). If left untreated, glaucoma can lead to irreversible blindness. There are several types of glaucoma including open-angle glaucoma, angle-closure glaucoma, congenital glaucoma, and secondary glaucoma caused by injuries, infections, tumors or inflammation. Treatment options include medications, laser treatment, or surgery to lower IOP and prevent further vision loss. The goal is early detection and treatment to preserve sight.
This document provides an overview of glaucoma, including:
1. It defines and classifies glaucoma as primary, secondary, or congenital. Primary glaucoma is further divided into open angle and angle closure glaucoma.
2. Examination methods for glaucoma are discussed like tonometry, gonioscopy, optic nerve examination, and visual field testing.
3. Primary open angle glaucoma and primary angle closure glaucoma are defined in more detail, including risk factors, clinical features, and management approaches.
4. Glaucoma surgeries like trabeculectomy and other filtration procedures are briefly discussed.
Glaucoma: the “silent thief of sight”
Glaucoma is a leading cause of preventable sight loss. Vision can often be preserved with early identification, good adherence to treatment and long-term monitoring.
This document provides an overview of primary angle-closure glaucoma (PACG). It defines PACG as a type of glaucoma caused by blockage of the aqueous humor outflow due to closure of the anterior chamber angle. The document classifies PACG and discusses its clinical presentations, including latent, subacute, acute, chronic, and absolute forms. Diagnosis involves gonioscopy and provocative tests. Management includes medications, laser iridotomy, and surgery. The goal is to reopen the drainage angle and lower intraocular pressure to prevent vision loss from optic nerve damage.
Gradual vision loss is caused by many conditions that develop over weeks to years. The most common causes are age-related macular degeneration, cataracts, glaucoma, diabetic retinopathy, and refractive errors. A thorough history and eye exam can help identify the cause by examining symptoms, visual acuity, the retina, and optic nerve. Treatment depends on the specific condition but may include eye drops, laser therapy, surgery, or lifestyle changes.
Primary angle closure glaucoma (PACG) involves blockage of the drainage angle between the iris and cornea, increasing intraocular pressure. It has acute, subacute, and chronic stages depending on symptoms and pressure changes. Treatment involves lowering pressure through medications, laser iridotomy to open the angle, or surgery if needed. A red eye from PACG presents with severe vision loss, pain, mid-dilated pupil, and high pressure, distinguishing it from conjunctivitis, uveitis, or other causes.
1) Primary angle-closure glaucoma occurs when the iris blocks the drainage angle of the eye, preventing aqueous humor from draining properly and increasing intraocular pressure. It is usually caused by pupillary block from apposition of the iris and lens.
2) Acute primary angle closure presents with sudden severe eye pain, blurred vision, headache, and nausea. Chronic primary angle closure develops slowly over time with peripheral anterior synechiae formation.
3) Risk factors include hyperopia, smaller eye size, and increasing age when the lens thickens. Treatment involves medical management to lower pressure urgently followed by laser iridotomy or surgery to permanently open the drainage angle.
Secondary glaucoma is caused by an underlying ocular or systemic disease that leads to increased intraocular pressure and potential vision loss. It can be classified based on the mechanism of pressure rise into open-angle or angle-closure glaucoma. Common causes include lens-induced glaucoma, pigmentary glaucoma, neovascular glaucoma due to retinal ischemia, inflammatory glaucoma, traumatic glaucoma, steroid-induced glaucoma, pseudoexfoliative glaucoma, and glaucoma following cataract surgery. Treatment depends on the underlying cause but may include medications, laser treatment, or surgery to lower pressure and prevent further optic nerve damage.
Primary angle closure glaucoma is caused by blockage of the aqueous humor outflow due to closure or narrowing of the anterior chamber angle. It progresses through stages from primary angle closure suspect to acute angle closure to angle closure glaucoma, where glaucomatous optic nerve damage and visual field defects are present. Risk factors include hyperopia, smaller anterior chamber angle, older age, and Asian ethnicity. Treatment begins with intravenous mannitol or glycerol to lower pressure urgently, followed by topical eye drop medications like beta-blockers or pilocarpine. The definitive treatment is laser iridotomy or trabeculectomy surgery to permanently open the drainage angle.
Glaucoma presentation for ophthalmology course, presented as a student seminar. Class location: ophthalmology unit, An-Najah National University Hospital.
Glaucoma is a group of eye diseases characterized by increased pressure in the eye due to excess fluid. If left untreated, it can cause damage to the optic nerve and result in vision loss and blindness. The two most common types are open-angle glaucoma, which develops slowly over time, and angle-closure glaucoma, which develops acutely and requires urgent treatment to prevent vision loss. Treatment involves medications or surgery to lower eye pressure and prevent further damage to the optic nerve. Nursing care focuses on administering eye drop medications correctly, providing a safe environment, teaching patients self-care techniques, and ensuring follow-up medical care.
Glaucoma is a group of eye disorders that cause damage to the optic nerve, often due to increased intraocular pressure. The most common type, primary open-angle glaucoma, has no symptoms until late stages and is a leading cause of blindness. It is diagnosed through visual field testing and examination of the optic disc for cupping. Treatment aims to lower pressure through eyedrops or surgery and stop further nerve damage, though past damage cannot be reversed. Acute angle closure glaucoma requires emergency care for severe symptoms including eye pain and blurred vision to prevent vision loss.
This document provides information about glaucoma, including its etiology, pathophysiology, clinical manifestations, types, and treatment options. It begins with an introduction to glaucoma as a group of disorders characterized by optic nerve damage and vision loss associated with increased intraocular pressure. The document then discusses the etiology and pathophysiology of glaucoma, describing how increased pressure damages the optic nerve. It outlines the clinical signs and symptoms of various types of glaucoma and concludes by explaining non-pharmacological and pharmacological treatment approaches that aim to lower intraocular pressure and prevent further vision loss.
Primary open angle glaucoma (POAG) is the most common type of glaucoma. It is characterized by a raised intraocular pressure, optic nerve damage, and visual field loss. Early signs include increased cupping of the optic nerve head and visual field defects like paracentral scotomas. Treatment aims to lower intraocular pressure through medications, laser therapy, or surgery to prevent further optic nerve damage and vision loss.
Acute Rise in IOP (Dr. Rasha, senior resident of ophthalmology)Hind Safwat
There are several potential causes of acute increases in intraocular pressure (IOP), including glaucomatocyclitic crisis (Posner-Schlossman syndrome), inflammatory open-angle glaucoma, retrobulbar hemorrhage or inflammation, traumatic glaucoma, pigmentary glaucoma, neovascular glaucoma, plateau iris syndrome, and malignant glaucoma. IOP increases above 40mmHg can rapidly damage the optic nerve and cause permanent vision loss within hours. Treatment depends on the underlying cause but generally involves topical medications to lower IOP such as beta-blockers, alpha-2 agonists, and carbonic anhydrase inhibitors as well as systemic therapies like oral acetazol
Congenital or infantile glaucoma occurs in babies and young children, usually within the first year of life. It is a rare condition caused by incorrect development of the eye's drainage system before birth. The mainstay treatment is surgical, through procedures like goniotomy or trabeculotomy to create an opening in the trabecular meshwork and improve aqueous outflow. These surgeries may need to be repeated if the first procedure fails to sufficiently lower intraocular pressure.
Glaucoma is a group of eye conditions characterized by optic nerve damage due to increased intraocular pressure caused by blocked drainage of the aqueous humor in the eye. It is a leading cause of blindness and risk increases with age, especially between 45-65 years old. Glaucoma is managed through medication, laser treatment, or surgery to facilitate drainage of aqueous humor and maintain safe intraocular pressure to prevent further optic nerve damage and vision loss. Strict lifelong treatment adherence and monitoring is important for glaucoma management and vision preservation.
This presentation describes all clinical aspects about primary open angle glaucoma ......
you can watch the illustrated video presentation at the following link : https://youtu.be/eA44Pu4l8Ow
Primary angle closure glaucoma (PACG) results from occlusion of the trabecular meshwork by the peripheral iris, obstructing aqueous outflow. It has several classifications including primary angle closure suspect (PACS), primary angle closure (PAC), and PACG. PACG is usually caused by pupillary block but can also be caused by non-pupillary block mechanisms. Risk factors include older age, female sex, Asian ethnicity, hyperopia, and shallow anterior chamber. Treatment involves laser iridotomy, medical therapy, and sometimes surgery.
POAG and PACG are two major types of glaucoma. POAG is caused by increased intraocular pressure due to improper drainage of fluid from the eye. It progresses slowly and causes damage to the optic nerve and visual field loss over time. PACG occurs when the iris blocks the drainage angle, often in hyperopic eyes, and can progress more rapidly. Treatment options include medications, laser therapy, and surgery to lower pressure and prevent further vision loss. Regular eye exams are important for early detection and management of glaucoma.
Primary congenital glaucoma is caused by abnormalities in the trabecular meshwork that result in elevated intraocular pressure. It presents in infants younger than 4 years old with symptoms of epiphora, photophobia, and blepharospasm due to corneal edema. On examination, signs include elevated IOP, corneal enlargement with Haab striae, and progressive optic nerve cupping. The main treatment is surgical, with goniotomy or trabeculotomy as first line options, and trabeculectomy or glaucoma drainage devices for refractory cases. Prognosis depends on degree of corneal scarring, anisometropia, amblyopia, and optic nerve
Retinal dystrophies are a group of degenerative retinal disorders with genetic and clinical heterogeneity. They can affect rods, cones, or both photoreceptors. Retinitis pigmentosa is the most common form of inherited retinal dystrophy and is characterized by rod degeneration followed by cone loss. It presents with night blindness, progressive peripheral vision loss, attenuation of retinal vessels, waxy pallor of the optic disc, and bone spicule pigmentation. Electroretinography shows a rod-cone pattern of dysfunction. Genetic testing can identify mutations in over 270 associated genes.
This document provides an overview of glaucoma, including:
1. It defines and classifies glaucoma as primary, secondary, or congenital. Primary glaucoma is further divided into open angle and angle closure glaucoma.
2. Examination methods for glaucoma are discussed like tonometry, gonioscopy, optic nerve examination, and visual field testing.
3. Primary open angle glaucoma and primary angle closure glaucoma are defined in more detail, including risk factors, clinical features, and management approaches.
4. Glaucoma surgeries like trabeculectomy and other filtration procedures are briefly discussed.
Glaucoma: the “silent thief of sight”
Glaucoma is a leading cause of preventable sight loss. Vision can often be preserved with early identification, good adherence to treatment and long-term monitoring.
This document provides an overview of primary angle-closure glaucoma (PACG). It defines PACG as a type of glaucoma caused by blockage of the aqueous humor outflow due to closure of the anterior chamber angle. The document classifies PACG and discusses its clinical presentations, including latent, subacute, acute, chronic, and absolute forms. Diagnosis involves gonioscopy and provocative tests. Management includes medications, laser iridotomy, and surgery. The goal is to reopen the drainage angle and lower intraocular pressure to prevent vision loss from optic nerve damage.
Gradual vision loss is caused by many conditions that develop over weeks to years. The most common causes are age-related macular degeneration, cataracts, glaucoma, diabetic retinopathy, and refractive errors. A thorough history and eye exam can help identify the cause by examining symptoms, visual acuity, the retina, and optic nerve. Treatment depends on the specific condition but may include eye drops, laser therapy, surgery, or lifestyle changes.
Primary angle closure glaucoma (PACG) involves blockage of the drainage angle between the iris and cornea, increasing intraocular pressure. It has acute, subacute, and chronic stages depending on symptoms and pressure changes. Treatment involves lowering pressure through medications, laser iridotomy to open the angle, or surgery if needed. A red eye from PACG presents with severe vision loss, pain, mid-dilated pupil, and high pressure, distinguishing it from conjunctivitis, uveitis, or other causes.
1) Primary angle-closure glaucoma occurs when the iris blocks the drainage angle of the eye, preventing aqueous humor from draining properly and increasing intraocular pressure. It is usually caused by pupillary block from apposition of the iris and lens.
2) Acute primary angle closure presents with sudden severe eye pain, blurred vision, headache, and nausea. Chronic primary angle closure develops slowly over time with peripheral anterior synechiae formation.
3) Risk factors include hyperopia, smaller eye size, and increasing age when the lens thickens. Treatment involves medical management to lower pressure urgently followed by laser iridotomy or surgery to permanently open the drainage angle.
Secondary glaucoma is caused by an underlying ocular or systemic disease that leads to increased intraocular pressure and potential vision loss. It can be classified based on the mechanism of pressure rise into open-angle or angle-closure glaucoma. Common causes include lens-induced glaucoma, pigmentary glaucoma, neovascular glaucoma due to retinal ischemia, inflammatory glaucoma, traumatic glaucoma, steroid-induced glaucoma, pseudoexfoliative glaucoma, and glaucoma following cataract surgery. Treatment depends on the underlying cause but may include medications, laser treatment, or surgery to lower pressure and prevent further optic nerve damage.
Primary angle closure glaucoma is caused by blockage of the aqueous humor outflow due to closure or narrowing of the anterior chamber angle. It progresses through stages from primary angle closure suspect to acute angle closure to angle closure glaucoma, where glaucomatous optic nerve damage and visual field defects are present. Risk factors include hyperopia, smaller anterior chamber angle, older age, and Asian ethnicity. Treatment begins with intravenous mannitol or glycerol to lower pressure urgently, followed by topical eye drop medications like beta-blockers or pilocarpine. The definitive treatment is laser iridotomy or trabeculectomy surgery to permanently open the drainage angle.
Glaucoma presentation for ophthalmology course, presented as a student seminar. Class location: ophthalmology unit, An-Najah National University Hospital.
Glaucoma is a group of eye diseases characterized by increased pressure in the eye due to excess fluid. If left untreated, it can cause damage to the optic nerve and result in vision loss and blindness. The two most common types are open-angle glaucoma, which develops slowly over time, and angle-closure glaucoma, which develops acutely and requires urgent treatment to prevent vision loss. Treatment involves medications or surgery to lower eye pressure and prevent further damage to the optic nerve. Nursing care focuses on administering eye drop medications correctly, providing a safe environment, teaching patients self-care techniques, and ensuring follow-up medical care.
Glaucoma is a group of eye disorders that cause damage to the optic nerve, often due to increased intraocular pressure. The most common type, primary open-angle glaucoma, has no symptoms until late stages and is a leading cause of blindness. It is diagnosed through visual field testing and examination of the optic disc for cupping. Treatment aims to lower pressure through eyedrops or surgery and stop further nerve damage, though past damage cannot be reversed. Acute angle closure glaucoma requires emergency care for severe symptoms including eye pain and blurred vision to prevent vision loss.
This document provides information about glaucoma, including its etiology, pathophysiology, clinical manifestations, types, and treatment options. It begins with an introduction to glaucoma as a group of disorders characterized by optic nerve damage and vision loss associated with increased intraocular pressure. The document then discusses the etiology and pathophysiology of glaucoma, describing how increased pressure damages the optic nerve. It outlines the clinical signs and symptoms of various types of glaucoma and concludes by explaining non-pharmacological and pharmacological treatment approaches that aim to lower intraocular pressure and prevent further vision loss.
Primary open angle glaucoma (POAG) is the most common type of glaucoma. It is characterized by a raised intraocular pressure, optic nerve damage, and visual field loss. Early signs include increased cupping of the optic nerve head and visual field defects like paracentral scotomas. Treatment aims to lower intraocular pressure through medications, laser therapy, or surgery to prevent further optic nerve damage and vision loss.
Acute Rise in IOP (Dr. Rasha, senior resident of ophthalmology)Hind Safwat
There are several potential causes of acute increases in intraocular pressure (IOP), including glaucomatocyclitic crisis (Posner-Schlossman syndrome), inflammatory open-angle glaucoma, retrobulbar hemorrhage or inflammation, traumatic glaucoma, pigmentary glaucoma, neovascular glaucoma, plateau iris syndrome, and malignant glaucoma. IOP increases above 40mmHg can rapidly damage the optic nerve and cause permanent vision loss within hours. Treatment depends on the underlying cause but generally involves topical medications to lower IOP such as beta-blockers, alpha-2 agonists, and carbonic anhydrase inhibitors as well as systemic therapies like oral acetazol
Congenital or infantile glaucoma occurs in babies and young children, usually within the first year of life. It is a rare condition caused by incorrect development of the eye's drainage system before birth. The mainstay treatment is surgical, through procedures like goniotomy or trabeculotomy to create an opening in the trabecular meshwork and improve aqueous outflow. These surgeries may need to be repeated if the first procedure fails to sufficiently lower intraocular pressure.
Glaucoma is a group of eye conditions characterized by optic nerve damage due to increased intraocular pressure caused by blocked drainage of the aqueous humor in the eye. It is a leading cause of blindness and risk increases with age, especially between 45-65 years old. Glaucoma is managed through medication, laser treatment, or surgery to facilitate drainage of aqueous humor and maintain safe intraocular pressure to prevent further optic nerve damage and vision loss. Strict lifelong treatment adherence and monitoring is important for glaucoma management and vision preservation.
This presentation describes all clinical aspects about primary open angle glaucoma ......
you can watch the illustrated video presentation at the following link : https://youtu.be/eA44Pu4l8Ow
Primary angle closure glaucoma (PACG) results from occlusion of the trabecular meshwork by the peripheral iris, obstructing aqueous outflow. It has several classifications including primary angle closure suspect (PACS), primary angle closure (PAC), and PACG. PACG is usually caused by pupillary block but can also be caused by non-pupillary block mechanisms. Risk factors include older age, female sex, Asian ethnicity, hyperopia, and shallow anterior chamber. Treatment involves laser iridotomy, medical therapy, and sometimes surgery.
POAG and PACG are two major types of glaucoma. POAG is caused by increased intraocular pressure due to improper drainage of fluid from the eye. It progresses slowly and causes damage to the optic nerve and visual field loss over time. PACG occurs when the iris blocks the drainage angle, often in hyperopic eyes, and can progress more rapidly. Treatment options include medications, laser therapy, and surgery to lower pressure and prevent further vision loss. Regular eye exams are important for early detection and management of glaucoma.
Primary congenital glaucoma is caused by abnormalities in the trabecular meshwork that result in elevated intraocular pressure. It presents in infants younger than 4 years old with symptoms of epiphora, photophobia, and blepharospasm due to corneal edema. On examination, signs include elevated IOP, corneal enlargement with Haab striae, and progressive optic nerve cupping. The main treatment is surgical, with goniotomy or trabeculotomy as first line options, and trabeculectomy or glaucoma drainage devices for refractory cases. Prognosis depends on degree of corneal scarring, anisometropia, amblyopia, and optic nerve
Retinal dystrophies are a group of degenerative retinal disorders with genetic and clinical heterogeneity. They can affect rods, cones, or both photoreceptors. Retinitis pigmentosa is the most common form of inherited retinal dystrophy and is characterized by rod degeneration followed by cone loss. It presents with night blindness, progressive peripheral vision loss, attenuation of retinal vessels, waxy pallor of the optic disc, and bone spicule pigmentation. Electroretinography shows a rod-cone pattern of dysfunction. Genetic testing can identify mutations in over 270 associated genes.
ECTROPION^JENTROPION AND THEIR MANAGEMENT 2.pptxHarshika Malik
This document discusses ectropion and entropion of the eyelids, including their causes, types, clinical evaluation, and management. Ectropion is the outward turning of the eyelid margin, while entropion is the inward turning. Involutional ectropion most commonly affects the lower eyelids in elderly patients due to gravitational changes. Management depends on the type but may include procedures to shorten the eyelid or correct underlying issues like laxity of the medial or lateral canthal tendons. Prompt treatment is important to prevent complications such as dry eye or corneal damage.
This document discusses episcleritis and scleritis. Episcleritis involves inflammation of the episclera and is typically benign and self-limiting. Scleritis involves inflammation of the sclera and can be more serious, potentially causing vision loss if untreated. Scleritis is classified as anterior (non-necrotizing or necrotizing) or posterior. Treatment involves topical steroids and NSAIDs for mild cases and systemic steroids and immunosuppressants for more severe or necrotizing forms. Both conditions require treatment of any underlying systemic diseases.
The document discusses the history and evolution of corneal transplantation (keratoplasty) from early experiments in the 18th-19th centuries to modern techniques. Some key events include the first successful human corneal transplant being performed by Eduard Zirm in 1906, the introduction of antibiotics and steroids improving outcomes in the 1940s, and recent advances with femtosecond lasers and other technologies. The document also reviews the various surgical techniques used for corneal transplantation and postoperative care considerations.
The document discusses lamellar keratoplasty, which involves replacing diseased corneal tissue while retaining normal tissue. It describes anterior lamellar keratoplasty (ALKP) and posterior lamellar keratoplasty (PLKP). ALKP replaces varying amounts of anterior corneal tissue, while PLKP replaces the Descemet's membrane and endothelium. The document also discusses indications, surgical techniques like the Anwar bubble technique, and complications for anterior lamellar keratoplasty. Posterior lamellar keratoplasty techniques like DSAEK are described to replace dysfunctional endothelium.
This document provides an overview of retinopathy of prematurity (ROP), including:
1) ROP is a disorder of the developing retina in premature infants that can lead to blindness if left untreated. It occurs when the retina is incompletely developed and blood vessels grow abnormally.
2) Risk factors include prematurity, low birth weight, excess oxygen exposure, and other medical complications. The pathogenesis involves abnormal vasoproliferation and retinal neovascularization due to disrupted retinal vascular development.
3) ROP is classified based on location within zones of the retina, stage of disease progression from mild to severe, and presence of "plus disease" indicating worse prognosis. Timely screening and treatment can
This document provides an overview of thyroid ophthalmopathy (TED), also known as Graves' ophthalmopathy. It discusses the epidemiology, etiology, risk factors, pathogenesis, clinical signs and symptoms, diagnosis, and management of the autoimmune disease. TED is caused by inflammation and accumulation of fluids in the orbit, raising pressure and causing enlargement of the extraocular muscles and adipose tissue. Symptoms include eye bulging, double vision, and dryness. Management involves treating any thyroid abnormalities, using corticosteroids, radiation, or surgery to address eye involvement and symptoms.
The orbit is a pyramidal space located between the anterior cranial fossa and the maxillary sinuses. It is formed by seven bones and contains the eyeball as well as nerves, blood vessels and extraocular muscles. Proptosis refers to forward displacement of the eyeball. It can be caused by infections, inflammation, vascular abnormalities, tumors or trauma based on characteristics like age of onset and laterality. Evaluation involves inspection of periorbital region and eye examination along with imaging studies and biopsy as needed to identify the cause which guides treatment.
Mechanical ocular trauma can cause a wide range of eye injuries from relatively minor to vision threatening. The document defines standard terminology for different types of eye injuries using the Birmingham Eye Trauma Terminology (BETT) system. It describes closed globe injuries which involve no penetration of the eyewall, open globe injuries which involve penetration of the eyewall, and different types of open globe injuries including globe rupture, penetrating injuries, and perforating injuries. It provides details on mechanisms of injury, clinical findings, examination techniques, and treatment approaches for different injury types.
Retinal detachment is defined as the separation of the neurosensory retina from the retinal pigment epithelium. There are three main types: rhegmatogenous retinal detachment caused by a retinal break, tractional retinal detachment caused by vitreous traction, and exudative retinal detachment caused by fluid accumulation beneath the retina. Rhegmatogenous retinal detachment is usually associated with a retinal break and treated surgically by sealing the break with photocoagulation or cryotherapy and using scleral buckling or vitrectomy to reattach the retina. Tractional and exudative retinal detachments are generally treated with vitrectomy but may also be treated medically or with laser in some cases
The document discusses the anatomy and physiology of ocular muscles. It describes:
1. The intrinsic and extrinsic muscles that control eye movement and pupil size/lens shape.
2. The origins, insertions, innervation and actions of individual muscles.
3. Principles of binocular vision including fusion, stereopsis, prerequisites for development and anomalies like suppression and amblyopia.
4. Types of strabismus like tropia, phoria, pseudostrabismus and their characteristics. Heterophoria is defined and compensated vs decompensated types discussed.
Diabetic retinopathy is a progressive dysfunction of the retinal blood vessels caused by chronic hyperglycemia. It can cause vision loss and blindness if not treated. The risk and severity of retinopathy increases with the duration of diabetes and poor blood sugar control. Early stages are characterized by microaneurysms and hemorrhages, while proliferative stages involve new blood vessel growth. Macular edema can occur at any stage and is a leading cause of vision loss. Treatment includes laser photocoagulation, anti-VEGF injections, and vitrectomy surgery depending on the severity of retinopathy and presence of macular edema. Strict blood sugar and blood pressure control can help prevent and slow the progression of diabetic ret
Optic Neuritis, Papilledema document discusses optic nerve conditions. It defines optic neuritis as inflammation of the optic nerve impairing nerve conduction that can be caused by demyelination, infection, or autoimmunity. Papilledema is defined as bilateral, non-inflammatory swelling of the optic disc due to increased intracranial pressure. The document covers causes, signs, symptoms, diagnostic tests, treatment, and prognosis for both conditions.
The retina is the innermost layer of the eye that contains photoreceptor cells. Retinoblastoma is a malignant tumor that arises from these photoreceptor cells in the retina, most commonly affecting young children under 5 years old. It can be hereditary if caused by a mutation in the RB1 gene, resulting in bilateral and multifocal tumors, or non-hereditary if caused by somatic mutations, usually presenting as a unilateral tumor. Treatment depends on tumor size and extent but may include chemotherapy, local therapies like cryotherapy or brachytherapy, and enucleation of the eye for advanced cases. Early diagnosis and treatment can help preserve vision and life.
This document discusses approaches to treating paediatric cataracts. It notes that paediatric cataract accounts for 7.4-15.3% of paediatric blindness worldwide. Etiologies include genetic factors, intrauterine infections, metabolic disorders, trauma, and prematurity. A thorough history, ocular exam, and laboratory tests are required to evaluate the cataract and check for associated ocular or systemic abnormalities. Surgical removal is indicated for visually significant cataracts. Challenges of paediatric cataract surgery include performing accurate biometry and intraocular lens power calculations due to the developing eye, achieving a stable anterior chamber, and addressing post-operative aphakia or amblyopia management.
This document discusses various types of ischemic optic neuropathies including anterior ischemic optic neuropathy (AION) and posterior ischemic optic neuropathy (PION). It describes the differences between arteritic AION (caused by giant cell arteritis) and non-arteritic AION, with the former affecting older patients and often causing bilateral simultaneous vision loss. Risk factors for NAION include hypertension, diabetes, and sleep apnea. The document provides details on clinical evaluation, imaging, and management of these vision-threatening conditions.
This document provides information on diseases of the lacrimal apparatus. It describes the anatomy of the lacrimal gland and drainage system. It discusses conditions such as dacryocystitis, which is inflammation of the lacrimal sac. Dacryocystitis can be congenital in infants due to blockage, or adult onset due to infection. Chronic dacryocystitis is more common and can lead to a lacrimal mucocele or pyocoele if left untreated. Surgical treatments like dacryocystorhinostomy are described to repair blockages and restore tear drainage.
The document discusses diseases of the lens, including its anatomy, transparency mechanisms, and types of cataracts. It describes the lens's structure and functions. For cataracts, it covers the differential diagnosis, etiological classification including congenital vs acquired cataracts, and morphological classification. Evaluation, indications for surgery, timing of surgery, intraocular lens power calculation and material selection, surgical techniques, and post-operative rehabilitation are summarized.
The document provides information on diseases of the uveal tract, which includes the iris, ciliary body, and choroid. It describes the anatomy, microscopic structure, blood supply, and functions of each part of the uveal tract. Uveitis, or inflammation of the uveal tract, is also discussed. The signs, symptoms, classifications, complications, and investigations for uveitis are summarized.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
2. DEFINITION
• Primary angle closure glaucoma is a type of
primary glaucoma(with no obvious systemic or
ocular cause) characterized by
occludable/closed angles leading to
obstruction of aqueous outflow resulting in
rise of intra ocular pressure, optic nerve
damage and visual field defects.
2
3. ANGLE OF ANTERIOR CHAMBER
• STRUCTURES
– Schwalbe’s line
– Trabecular meshwork
– Scleral spur
– Ciliary body band
– Root of iris
3
5. PRIMARY ANGLE CLOSURE
GLAUCOMA
EPIDEMIOLOGY
• PACG is the major cause of glaucoma blindness
worldwide.
• Age :- Average age at presentation 50-60 yrs
• Gender :- F > M, 4 : 1
• Race :-seen commonly in South-East Asian
population, Chinese and Eskimos
• Heredity :- mostly sporadic but may be inherited
AD/AR
– first degree relatives are at increased risk.
• Refractive error :- more common in
hypermetropes 5
6. Ocular risk factors
1. Shallow anterior chamber both
centrally and peripherally.
2. Decreased anterior chamber volume.
3. Short axial length of the globe.
4. Small corneal diameter.
6
7. Ocular risk factors
5.Decreased posterior corneal radius of
curvature
6.Anterior position of the lens with respect to
the ciliary body.
7.Increased curvature of the anterior surface &
thickness of lens 7
8. PATHOGENESIS
• It is incompletely understood.
» a. Iris–pupil obstruction (e.g., ‘pupillary block’)
» b. Ciliary body anomalies (e.g., ‘plateau iris syndrome’)
» c. Lens–pupil block (e.g., ‘phacomorphic block’ (swollen
lens or microspherophakia))
• Relative Pupillary block
• Normally the pressure in the post. chamber exceeds that in the ant.
chamber due to physiological degree of resistance at the pupil ,since the
iris rests posteriorly on the anterior lens capsule.
8
9. Anterior Iris Bowing
Simultaneous dilatation of the pupil renders the peripheral
iris more flaccid. The pupil block causes the pressure in the
Posterior Chamber to increase & peripheral iris bows
anteriorly
9
13. CLASSIFICATION
A. Primary angle-closure disease
• Irido-trabecular contact is the final common pathway of
angle closure disease, obstructing aqueous outflow
1. New classification
Primary angle closure suspect/PACS
Primary angle closure/PAC
Primary angle-closure glaucoma/PACG
2. Old classification
Angle closure suspect
Intermittent (sub acute) angle closure
Acute angle closure
Chronic angle closure
Absolute angle closure 13
14. New classification of PACG
Primary angle closure suspect/PACS
Has occludable/narrow angles
Primary angle closure/PAC
Has occludable/narrow angles +
High IOP/Peripheral anterior synechiae/
Excessive trabecular meshwork
pigmentation
Primary angle-closure glaucoma/PACG
PAC+ Optic disc changes+ Visual field
defects
14
15. Gonioscopic grading of Angle
closure
• Several grading systems :- Shaffer’s, Spaeth’s,
Scheie’s.
• Shaffer’s grading
Grade Angle width configuration Chances of
closure
Structures visible
IV 35°-45° Wide open Nil SL,TM,SS,CBB
III 20°-35° Open angle Nil SL,TM,SS
II 20° Moderately open Possible SL,TM
I 10° Very narrow Highly likely SL only
0 0° Closed Closed None
15
18. Tests for Angle closure
• Eclipse test : uses flash light to make a rough
assessment of angle depth
• Provocative tests for PAC suspects
Prone- darkroom test: An increase in IOP of more
than 8mm Hg after one hour suggests PAC
Mydriatic provocative test: Not preferred now
Fincham’s Test: Also known as stenopaeic-slit test.
Glaucomatous halos remain intact , whereas
halos due to cataract are broken up into segments
18
19. PRIMARY ANGLE CLOSURE GLAUCOMA SUSPECT
• Also known as Latent PACG
• Essentially, the term implies
an anatomically predisposed
eye.
• Symptoms :- absent
• Signs :
– Axial AC depth is < normal
& iris lens diaphragm is
convex
– Close proximity of the iris
to the cornea
– Gonioscopy :- occludable
angle(grade 1 or 0)
without indentation in at
least 3 quadrants. 19
20. •Clinical course without
treatment may be:
IOP may remain normal
Acute or sub acute angle
closure may ensue
Chronic angle closure may
develop, without acute or
sub acute stages.
20
21. • Treatment
• Without treatment , risk of an acute pressure rise during the next
5 years is about 50 %.
• The need to treat is based on following criteria:-
– If one eye has had acute or subacute angle closure, then
fellow eye should undergo prophylactic peripheral laser
iridotomy (Laser PI)
– If both eyes have occludable angles, laser PI may be done
21
22. INTERMITTENT(SUBACUTE)PRIMARY ANGLE CLOSURE
GLAUCOMA
• A form of pupillary block glaucoma, which may not have
any recognizable symptoms.
• Occurs in a predisposed eye with an occludable angle in
association with intermittent pupillary block.
• Precipitating factors :- physiological mydriasis , or
physiological shallowing of AC when patient assumes a
prone or semi prone position ;emotional stress.
22
23. • Symptoms
– Characteristic h/o transient blurring of vision with haloes
around lights
– Ocular discomfort or frontal headache
– Attacks are recurrent and are usually broken after 1-2 hrs by
physiological miosis.
• Signs
– During an attack , eye is usually white
– In between attacks, eye looks normal although the angle is
narrow.
• Clinical course
– Without treatment is variable
• Some eyes develop an acute attack
• Others chronic angle closure
• Treatment:- Prophylactic laser PeripheraI Iridotomy(PI) 23
24. ACUTE PRIMARY ANGLE CLOSURE GLAUCOMA
• Sight threatening emergency
• Painful loss of vision due to sudden and total
closure of the angle.
• VA usually 6/60-Hand Movements.
• IOP is usually very high (40–70 mmHg).
24
25. Findings during an acute attack of angle-closure glaucoma
• Two of the following symptom sets:
– Periorbital or ocular pain
– Diminished vision
– Specific history of rainbow haloes with blurred vision
• IOP > 21 mmHg plus three of the following
findings:
– Ciliary flush (perilimbal conjunctival hyperemia)
– Corneal edema (epithelial,stromal)
– Shallow anterior chamber
25
26. Findings during an acute attack of angle-closure glaucoma
– Anterior chamber cell and flare
– Mid-dilated ,vertically oval and sluggishly reactive
pupil
– Closed angle on gonioscopy
– Hyperemic and swollen optic disc(due to
decreased axoplasmic outflow)
– Constricted visual fields
26
27. • MANAGEMENT
• Patient comfort ,lowering of the IOP and to break acute
attack— main priorities.
• A. Immediate medical treatment
1. Patient should lie supine to allow the lens to shift
posteriorly.
2. Acetazolamide 500 mg orally(if there is no vomiting).
or I.V Mannitol 20% 1-2 g/kg over 1 hour (rule out
contraindications)
3.Topical
Prednisolone or dexamethasone q.i.d (if AC reaction)
Timolol (if there is no contraindication).
4. Analgesia and emetics as required. 27
28. • B. Subsequent medical treatment
Pilocarpine 2% q.i.d. to the affected eye and 1% q.i.d. to
the fellow eye.
Topical steroids (prednisolone 1% or dexamethasone 0.1%)
q.i.d. if the eye is acutely inflamed.
Timolol 0.5% b.d.,
and oral acetazolamide 250 mg q.i.d. may be required.
• If the above measures fail:
– Laser iridotomy or iridoplasty after clearing corneal oedema with
glycerol.
– Surgical options in resistant cases include lens extraction,
goniosynechiolysis, trabeculectomy and cycloablation.
28
29. • Findings suggestive of previous episodes of acute
angle closure glaucoma
– Descemets Membrane folds
– Fine pigment granules on corneal endothelium
– Peripheral anterior synechiae
– Posterior synechiae
– Glaucomflecken
– Sectoral/generalized iris atrophy
– Fixed and semi dilated pupil
– Optic nerve cupping &/or pallor
– Gonioscopy shows narrow angle
or PAS
– Visual field loss
29
30. Chronic angle closure glaucoma
• Visual Acuity is normal unless damage is
advanced.
• Anterior chamber is shallower in pupillary
block than non-pupillary block.
• Optic nerve signs depend on severity of
damage.
• IOP elevation may be only intermittent.
• Gonioscopic abnormalities-Peripheral
Anterior Synechiae, narrow angle,
pigmentation of Schwalbe’s line.
30
31. Treatment of chronic angle closure
• Medical treatment is similar to that of POAG
• Prostaglandin/Prostamides
Latanoprost, Bimatoprost, Travoprost
• Beta blockers
Timolol maleate, Betaxolol
• Carbonic anhydrase inhibitors
Dorzolamide, Brinzolamide
• Sympathomimetics
Brimonidine, Apraclonidine
• Parasmpathomimetics
Pilocarpine
• Oral carbonic anhydrase inhibitors
Acetazolamide, Methazolamide
31
32. Treatment of chronic angle closure
• Laser Peripheral Iridotomy (PI) in affected eye
along with Prophylactic PI in fellow eye
32
34. • Surgical treatment
Trabeculectomy (filtering surgery) is the
surgical procedure of choice
• Success:- 87- 100 % with multiple operations
• Complications:-
– Flat AC, hypotony
– Bleb related infections
– Cyclodialysis
• PATIENTS REQUIRE REGULAR AND LIFE LONG
FOLLOW UP
34
35. Absolute glaucoma
• Is the final/last stage of PACG
• Clinical features:
Painful blind eye
Perilimbal reddish blue zone, due to dilated
anterior ciliary veins
Cornea gradually becomes hazy, insensitive
with bullous keratopathy and filamentary
keratitis
Anterior chamber is very shallow/flat
35
36. Clinical features of absolute glaucoma
Iris is usually atrophic
Pupil is fixed and dilated
Glaucomatous optic atrophy of the optic disc
High IOP
36
37. Management of absolute glaucoma
• Cycloablation/destruction of the secretory
ciliary epithelium
Cyclophotocoagulation
Cyclocryotherapy
Cyclodiathermy
• Rarely
• Retrobulbar alcohol injection
• Enucleation of eyeball
37