More Related Content
What's hot
What's hot (20)
Similar to Clinical features of glaucoma
Similar to Clinical features of glaucoma (20)
Recently uploaded
Recently uploaded (20)
Clinical features of glaucoma
- 1. Clinical Features of glaucoma Dr.Sidesh Hendavitharana(Registrar- ophthalmology)
- 2. Etiological classification of glaucoma • primary – Children • True congenital glaucoma • Infantile glaucoma • Juvenile glaucoma – Adults • Primary open angle glaucoma • Primary angle closure glaucoma
- 3. secondary • Children – Aniridia – Iridocorneal dysgenesis – Ectopia lentis syndrome – Lowe’s syndrome – Rubella • Adults – Phacogenic glaucoma – Pigmentary glaucoma – Pseudoexfoliative glaucoma – Inflammatory glaucoma – Neovascular glaucoma – Ghost cell glaucoma
- 4. Clinical features of congenital glaucoma • Symptoms – Photophobia,blepharospasm and eye rubbing due to irritation of corneal nerves because of elevated IOP. – Lacrimation due to corneal edema and erosion. – Defective vision due to corneal edema leading to hazy cornea ,enlarment of cornea and eye as a whole. – Irritable child.
- 5. signs • Corneal edema(Hazy frosted glass cornea) – 1st sign to arouse suspicion – At first,epithelial,lateral stromal – Results in permanent opacities • Corneal enlargement – Along with enlargement of eyeball – Cornea more than 13mm(normal 10.5mm in infants) • Tears and breaks in Descemet’s membrane(haab striae) – Because of less elasticity – Appear as horizontal curvilinear lines representing healed breaks of descemet membrane
- 6. .
- 7. . • .
- 8. . • .
- 9. . • Thin and blue sclera(due to stretching of corneoscleral junction) • Flattening of lens and backward displacement (due to stretching of zonules of zinn) and even subluxation of lens. • Cupping and atrophy of optic disc especially after 3rd yr • Raised IOP • Axial myopia(due to increased in axial length) anisometropic amblyopia
- 10. Clinical features of primary open angle glaucoma • Symptoms – Painless,progressive loss of vision – Mild headache and eyeache – Defects in visual fields – Difficulty in reading and close work(due to failure in accomodation because of constant pressure on cilliary muscles and its nerve supply)thus frequent changes in presbyopic glasses – Delayed dark adaptation
- 11. signs • Anterior segment – Normal depth and angle of anterior chamber – Slightly hazy cornea(late stage)sluggish pupillary reflex(late stages) – IOP changes – In initial stages ,rhythmic swing in diurnal variation of IOP(morning rise 20%,afternoon rise 25%) – Variation of >5mm of Hg of IOP is suspicious and >8mm of Hg is diagnostic – In late stages, IOP raised permenently above 21 mmHg, usually between 30-45mmHg
- 12. Optic disc changes • Typically progressive and asymetric. • Pathophysiology – Mechanical effect • Raised IOP , forces lamina cribrosa backward squeezes nerve fibres within its meshes disturbance in axoplasmic flow – Vascular factors • Contribute in ischemic atrophy of nerve fibres resulting in large caverns or lacunae(cavernous optic atrophy)
- 13. Early changes • Vertically oval cup(due to selective loss of neural rim tissue in inferior and superior poles) • Asymetry of cups in both eye(difference more than 0.2) • Large cup,0.6 or more due to concentric expansion • Splinter haemorrhage on or near optic disc margin • Pallor areas on disc • Atrophy of retinal nerve fiber layer(seen with red free light) • Barring of curcumlinear vessels at disc margin
- 14. . • .
- 15. . • .
- 16. . • .
- 17. . • .
- 18. . • .
- 19. Advanced changes • Marked cupping(cup size 0.7-0.9)-bean pot cupping • Excavation reaching disc margin,steep and no shelving • Thinning of neuroretinal rim seen as cresentic shadow adjecent to disc margin on temporal side • Nasal shifting of retinal vessels with broken off appearance at margin(bayonetting sign) • Pulsation of retinal arteries at disc margin • Pores in lamina cribrosa slit-shaped and visible up to disc margin(laminar dot sign) • Glaucomatous optic atrophy • Destructon of all neural tissue of disc • Optic nerve head appears white and deeply excavated.
- 20. . • .
- 21. . • .
- 22. . • .
- 23. . • .
- 24. Clinical features of ACG • Symptoms – Asymptomatic but during attack transient blurring of vision,coloured halos and mild headache • Signs – Eclipse sign • Shadow on nasal side elicited by shining penlight across anterior chamber from temporal side • Indicates decreased axial anterior chamber depth
- 25. Slit lamp examination • Congested episcleral and conjunctival blood vessels • Corneal epithelial edema • Shallow anterior chamber • Mild amount of aqeous flare and cells • Mid dilated,sluggish and irregularly shaped pupil • Convex lens-iris diaphragm • Glaukomflecken-characteristic small anterior subcapsular lens opacities
- 26. Secondary glaucoma • Clinical features of neovascular glaucoma • Symptoms – Severe pain – Markedly reduced vision • Signs – Ciliary and episcleral congestion – Corneal edema – High IOP – Rubeosis iridis
- 27. Causes for NVG • CREDITS…… • C-CRVO • R-RD • E-eale’s disease • D-diabetic retinopathy • I-intraocular inflammations • T-Tumors(intraocular) • S-sickle cell retinopathy
- 28. Pseudoexfoliation syndrome • Clinical features – Effects elderly – Presents like primary open angle glucoma – Diposition of amorphous grey dandruff like material on pupillary border,anterior lens surface,posterior surface of iris,zonules and cilliary processes – Arrangement of pigments anterior to schwalbe’s line-sampaolesi line. – Subluxation of lens due to looseness of zonules
- 29. Clinical features of pigmentary glaucoma • Pigment diposition on the corneal endothelium in a vertical spindle pattern-krukenberg spindle(absolutely necessary to make the diagnosis) • Peripheral iris transillumination-characteristic spokelike loss of the iris pigment epithelium • When the pupil is dilated,pigment deposits can be seen on the zonular fibres,anterior to hyaloid and the lens capsule near the equator of the lens(zentmayer line)
- 30. THANK YOU • .