2. DEFINITION
• Glaucoma can be defined as a group of diseases that
have a common characteristic of progressive optic
neuropathy with corresponding characteristic visual
field defect where IOP is an important risk factor.
13. VISUAL FIELD DEFECT IN GLAUCOMA
• Generalised depression of sensitivity.
• Isolated paracentral scotoma.
• Seidel’ scotoma.
• Roenne’s nasal step.
• Arcuate scotoma.
• Double arcuate or ring scotoma.
• Tubular field.
• Only temporal island of vision.
• Total field loss
14. INTRA OCCULAR PRESSURE
• It is the lateral pressure exerted on the outer coat of eyeball by intraocular
contents specially the aqueous humour.
• Normal range : 11 – 21 mmHg.
• In glaucoma the raised IOP is due to aqeous outflow obstruction.
15. AQUEOUS PRODUCTION & DRAINAGE
PATHWAY
• Formed in the ciliary region
• Flows from posterior chamber to anterior chamber
through the pupil
• Angle of the anterior chamber
• Trabecular meshwork
• Schlemm’s canal
• Aqueous veins
• Episcleral venous plexus.
18. MECHANISMS OF ANGLE-CLOSURE
GLAUCOMA:
• Building up of aqueous in posterior chamber.
• Forward bowing of the peripheral iris,resembling as ‘iris bombe’.
• Closure of the anterior of the anterior angle.
• Sharp rise in interocular pressure
19. STRUCTURE OF ANTERIOR CHAMBER ANGLE
• Schwalbe line.
• Trabecular meshwork
• Anterior trabecular meshwork.
• Posterior trabecular meshwork- Schlemm canal.
• Scleral spur.
• Ciliary body.
The process of examining the angle – Gonioscopy.
Instrument – Gonioscope.
20. ACUTE ANGLE CLOSURE GLAUCOMA
• Is an ophthalmic Emergency.
• Definition: Acute high rise of IOP due to acute angle clouser is known as Acute
angle clouser glaucoma.
21. ACUTE ANGLE CLOSURE GLAUCOMA
• Risk factors:
• Age: 4th – 5th decade.
• Sex: Female : Male = 4: 1
• Personality: Emotional & nervous people.
• Family history: Usually positive.
• Eye: Short axial length with shallow AC
• Refractive status: Hypermetropic.
32. ACUTE ANGLE CLOSURE GLAUCOMA
• Treatment :
• Hospitalization
• Initial treatment:
• Patient is advised to lie in supine position.
• Acetazolamide 500mg orally.
• Topical Timolol 0.5%, Prednisolone 1% one drop each in 5 minutes interval.
• Topical pilocarpine 2% one drop in each eye and ½ hourly in affected eye until
constrict.
• Analgesic – NSAIDS
• Antiemetic.
33. ACUTE ANGLE CLOSURE GLAUCOMA
• If IOP does not fall significantly(In registent case)
• 50% glycerol orally or 20% mannitol I/V is given.
• Topical 50% glecerol to improve corneal oedema.
34. • Further treatment( after 48 hours): after gonioscopy
• LPI – if PAS is < 50%
• Trabeculectomy – if PAS is >50%
• LPI in fellow eye.