Glaucoma is a condition characterized by increased intraocular pressure (IOP) that can damage the optic nerve and result in vision loss. The normal IOP range is 10-20 mmHg. IOP can be measured using contact tonometry such as Goldmann applanation tonometry or non-contact air-puff methods. Primary open-angle glaucoma is the most common type, where the angle remains open but drainage is blocked, causing increased IOP. It typically affects those over 40 and can be managed through eyedrops or surgery. Primary closed-angle glaucoma is a medical emergency where the iris blocks the drainage angle, rapidly increasing IOP and requiring immediate treatment to prevent vision loss.

1. GLAUCOMA
-
Presented by;
Smineela Tambe

2. INTRAOCULAR PRESSURE can be defined as internal pressure exerted
by the intraocular fluids on the coats of the eyeball.
The normal IOP is 10-20mm of Hg.

3. TECHNIQUES FOR MEASUREMENT OF IO
1) Manometry - It is measured by inserting a cannula directly into the
anterior chamber and the cannula is directly connected with
manometer.
 Most accurate method but impossible in clinical practice and only
useful for animals.
2) Digital Tonometry - IOP is roughly assessed by digital palpitation.
 Performed by asking the patient to look down and with the help of
two index fingers pressing ulternately over the upper lid.
 If the IOP is very high,this fluctuation will be stony hard or in case of
very low IOP it is soft,light like a water bag.

4. INSTRUMENTAL TONOMETRY
TONOM
ETER
CONTAC
T
Applatio
n
Indentati
on
NON-
CONTAC
T
Air-puff

5. APPLANATION
It is based on the principle of Imbert Fick’s law which states that, for
an ideal ,thin walled sphere, the pressure inside the sphere [P] equals to
the force necessary to flatten its surface[F] divided by the area of
flattening.
P = F/A

6. 1) GOLDMANN APPLANATION TONOMETER
It is very accurate variable-force tonometer consisting of a double
prism.

7. Fluorescein stained semicircles
seen during tonometry

8. 1) PARKIN’S HANDHELD TONOMETER
Does not require any slit lamp.
It is portable.
Can be used in supine position.

9. 3) SCHIOTZ TONOMETER (INDENTATION TONOMETER)
 PRINCIPLE – A plunger will indent a soft eye more than a hard eye.

10. NON-CONTACT TONOMETER
AIR-PUFF NCT- Puff of air flattens the corneal surface and gives the
reading in digital format.
No local anasthesia is required.
No chance of cross infection.
Accuracy is satisfactory.
Disadvantage is the instrument is costly and not handy.

11. NON-CONTACT TONOMETER

12. Tonometers
Goldmann
Contact applanation
Perkins
Portable contact applanation
Pulsair 2000 (Keeler)
Air-puff
Schiotz
Portable NCT applanation
Non-contact indentation
Contact indentation
Tono-Pen
portable contact applanation

13. GLAUCOMA is a multi factorial optic neuropathy in which there is a
characteristic loss of retinal ganglion cells and atrophy of the optic
nerve.
-AMERICAN ACADEMY OF OPHTHALMOLOGY
The personal integrity of eye is disturbed, resulting in characteristic
irreversible loss of visual field due to rise in IOP and optic disc head
changes.
GLAUCOMA is a condition in which the IOP of the eyeball
increases more than normal.

14. FACTORS CAUSING RISE IN IOP :
Increase in the volume of intra ocular contents.

15. External pressure along the globe
Blockage in the drainage system

16. GLAUCOMA
ACQUIRED
PRIMARY SECONDARY
CONGENITAL
BUPHTHALMUS
CLASSIFICATION

17. 1) INFANTILE GLAUCOMA
(BUPHTHALMUS,HYDROPHTHALMUS)
ETIOLOGY:
 Congenital
 Boys are more affected than girls
 Bilateral
 Causative mechanism-Congenital abnormality at the angle of
anterior chamber.

18. BUPHTHALMUS

19. Signs:
Corneal oedema

20. Epiphora

21. Enlarged eyeball

22. Tear in Descemet’s membrane

23. Blepharospasm
SYMPTOMS:
Photophobia
Defective vision

24. Diagnostic criteria:
Enlarged eyeball with raised IOP
Oedema or linear opacities of cornea
Cupping of the optic disc

25. TREATMENT: (Not very satisfactory)
Surgical-Goniotomy .

26. Trabeculectomy

27. 1) PRIMARY OPEN ANGLE GLAUCOMA:
-No obvious cause for the rise in IOP and the angle of anterior
chamber remains wide.
.
ACQUIRED GLAUCOMA

28. Symptoms:
 Mild headache and eye ache.
 Frequent changes in presbyopic
glasses.
 Defect in visual field.
Signs:
 Rise in IOP.
 Change in optic disc head.
 On Gonioscopy,angle is widely open.
Etiology:
 After age of 40.
 Slightly more in males.
 Bilateral.
 High degree of Myopia.
 Causative mechanism- interference
with aqueous outflow

29. GRADING FOR PAOG:
Grade I : Angle can be seen till Schwalbe’s line.
Grade II: Trabecular Meshwork.
Grade III: Scleral spur.
Grade IV: Ciliary body band.

30. Angle structures
Schwalbe line
Schlemm canal
Trabeculum
Scleral spur
Iris processes

31. 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
• Angle closure possible but unlikely
3 2 1
0
4

32. FIELD DEFECTS IN PAOG:
1) Barring of blind spot.
2) Seidel’s sign.
3) Bjerrum’s (arcurate) scotoma.
5) Double Arcurate scotoma.
6) Rone’s nasal step.
7) Peripheral defect.
8)Tubular vision.

33. Barring of blind spot

34. Arcurate scotoma

35. Double arcurate

36. TREATMENT:
Pilocarpine nitrate 2% e/o 2-3 times a day.
Timolol maleate.
Diamox tablets given orally twice or thrice daily.
Surgical:
1) Trabeculectomy.
2)Elliot’s Sclero-Corneal Trephine.

37. PRIMARY CLOSED ANGLE GLAUCOMA (Acute Congestive Glaucoma):
Etiology:
Common at 45-60years of age.
Females are more affected than males.
Hypermetropic eye.
Eye with narrow angle.
Symptoms:
Blurring of vision.
Photophobia.
Nausea and vomiting.
Pain in eye.

38. Signs:
Sudden rise in IOP.
Anterior chamber is shallow.
Cupping of the disc.
Pupil is moderately dilated.

39. Clinical course of PCAG has been divided
into five stages:
A) Prodromal stage.
B) Phase of constant instability.
C) Acute congestive attack.
D) Chronic congestive stage.
E) Stage of absolute glaucoma.

40. SECONDARY GLAUCOMA: due to some pre-existing disease.
Causes:
Due to inflammation.
Lens induced glaucoma.
Intra-ocular haemorrhage.
Aphakic glaucoma(post-operative)

41. Signs:
Gradual dimness of vision.
Raised IOP.
Cornea may be slightly hazy.
Treatment:
Hydrocortisone acetate 1% e/o every
 2-3hours is most effective.
Diamox 1tablet daily.

42. ABSOLUTE GLAUCOMA:
Signs:
Eye is completely blind.
Cornea is hazy and insensitive.
Anterior chamber is shallow.
IOP is high.

43. Treatment:
Pilocarpine nitrate 2% 3times daily.
Diamox tablets 3times a day.
Hydrocortisone acetate 1% e/o every 1 hour.
Timolol maleate.
Surgical.