Glaucoma is a condition where fluid pressure inside the eye rises above healthy levels, which can damage the optic nerve and cause vision loss or blindness if untreated. The two main types are primary open-angle glaucoma, the most common, and closed-angle glaucoma, which is a medical emergency. Treatment aims to lower intraocular pressure through eyedrops, laser treatment, or surgery depending on the type of glaucoma. Regular eye exams are important for early detection and treatment.

1. GLAUCOMA

2. Glaucoma: A common eye condition in which the
fluid pressure inside the eye rises to a level higher
than healthy for that eye. If untreated, it may damage
the optic nerve, causing the loss of vision or even
blindness.
TYPES:
1) Primary Open angle glaucoma
2) Closed angle glaucoma
EPIDEMIOLOGY:
1) PRIMARY 0PEN ANGLE GLAUCOMA:
•Also known as chronic simple glaucoma.
•Associated with a relative obstruction to aqueous
outflow through the trabecular meshwork and is a
chronic progressive disease of insidious onset,

3.  It is the most common type.
 Affects approximately 1 in 200 of population over the
age of 40 years.
 Responsible for about 20% of all cases of blindness in
UK and effects both sexes equally.
 Most people who develop open-angle glaucoma don’t
experience any noticeable symptoms at first. That’s
why it’s critical to have regular eye exams, so that
your eye doctor can detect problems early on.
Symptoms of open-angle glaucoma are:
 Gradual loss of peripheral vision, usually in both eyes
 Tunnel vision in the advanced stages

4. 2) CLOSED ANGLE GLAUCOMA:
 Also known as primary angle closure glaucoma.
 Condition in which closure of the angle by the
peripheral iris results in a reduction in aqueous
outflow.
 Occurs in predisposed eyes and is frequently
unilateral.
 Affects approximately 1 in 1000 caucasian adults over
the age of 40 years, about 1 in 100 Asians.
 Occurs in 4 times as many females as males.
 Acute angle-closure glaucoma is a medical
emergency and must be treated immediately or
blindness could result in one or two days

5. Acute angle-closure glaucoma signs and symptoms
include:
 Severe eye pain
 Nausea and vomiting (accompanying the severe eye
pain)
 Sudden onset of visual disturbance, often in low light
 Blurred vision
 Halos around lights
 Reddening of the eye
 Secondary glaucomas:
 Can raise for a number of reasons, including
inflammation, intra ocular tumour, raised episcleral
venous pressure or congentially due to developmental
abnormalities.

6. TREATMENT:
Primary open angle glaucoma:
 AIM: To decrease the raised intra ocular pressure to
the target value, preventing further damage to the
nerve fibres & the development of further visual field
defects.
 Key to effective treatment is careful and regular follow
up including measurement of visual activity, tonometry,
gonioscopy, evaluation of the optic disc & perimetry
(primary imp).
 Topical administration is the preferred type of therapy
and there is a wide range of preparations available:

7. THERAPEUTIC
CATEGORY
PRIMARY MECHANISM
OF ACTION
 Topical beta blocking
agent
 Topical miotics
 Topical adrenergic
agonists
 Topical carbonic
anhydrase inhibitors
 Topical prostaglandins
 Topical prostamides
 Decrease aqueous
formation
 Increase aqueous
outflow
 Increase aqueous
outflow
&Decrease aqueous
formation
 Decrease aqueous
formation
 Increase aqueous
outflow

8.  Drug should be administered at its lowest
concentration.
 1st line drugs: 1)Prostaglandin analogues:
Latanoprost, Travoprost, Prostamide bimatoprost
2) Beta blockers: Bitoxolol, Timolol,
Dorzolamide
 Carbonic anhydrase inhibitors & Sympathomimmetics
are used in patients in which first line drugs are
contraindicated.
 Initial topical treatment: Prostamide or prostaglandin
analogues, are used, if not effective another
prostaglandin analogue or beta blocker are used
 Pilocarpine is used for those, not controlled by above
combinational drugs.
 Oral Carbonic anhydrase inhibitors are used for final
stage of treatment.

9. •Sturtton and Walt (2004) were proposed newer therapies
to decrease surgeries in Glaucoma.
•Most frequently used surgeries are to create fistula to act
as new route for aqueous out flow
•Argon laser trabeculoplasty (ALT) : To increase aqueous
humour outflow , it is used for moderate glaucoma & IOP <
30mm Hg.

10. 2) Closed angle Glaucoma:
 Eye surgeries are done to treat closed angle
glaucoma.
 AIM: T o decrease intra ocular pressure and
associated inflammation.
 Analgesics & Antiemetics :
 Treat unaffected eye
prophylactically with miotics
(in table).

11.  If IOP > 60mm Hg indicates paralysis of iris sphincter
due to ischemia.
 Intensive miotic therapy is the treatment of choice.
 Intravenous administration of Acetazolamide followed
by its oral administration.
 If corneal indentation and Acetazolamide fail to
decrease IOP, Hyper osmotic agents may be required.
 Surgeries such as peripheral iridectomy, Laser
iridotomy to remove an area of the peripheral iris to
allow flow of aqueous humour through an alternative
pathway.

12. •Large angle has been closed by adhesion between iris and
cornea.