The document discusses secondary glaucoma, a condition where known ocular or non-ocular disorders affect aqueous outflow, leading to increased intraocular pressure (IOP). It outlines various classifications, including angle closure and open-angle types, along with key conditions such as pseudoexfoliation glaucoma and neovascular glaucoma. Treatment strategies are also summarized, depending on the specific type of secondary glaucoma identified.

1. Secondary
Glaucoma
Subtitle
By
Dr. Amr Mounir
Lecturer of Ophthalmology
Sohag University

2. Background
- Glaucoma is a group of irreversible, progressive
optic neuropathies that can lead to severe visual field
loss and blindness.
- May be primary or
secondary

3. Background
In primary glaucoma, the elevation of IOP is not
associated with any other ocular disorder
In secondary glaucoma a recognizable ocular or
non-ocular disorder alters aqueous outflow which,
in turn, results in elevation of IOP.

4. Secondary
glaucoma

5. Classification
Secondary glaucoma
2ry Angle
Closure
2ry Open
Angle

6. 2ry Angle Closure
With pupillary block
- Miotic induced.
- Swollen lens induced
glaucoma (Phacomorphic
glaucoma).
- Mobile lens induced glaucoma
(ectopia lentis,
microspherophakia).
- Posterior synechiae (to lens,
vitreous, or IOL).
Without pupillary block
a) Anterior pulling mechanism:
pulling the iris forward by
contraction of a membrane e.g.
late neovascular glaucoma and
inflammatory membrane.
b) Posterior pushing mechanism:
pushing the iris forward by a
condition in the posterior
segment e.g. Malignant
glaucoma and intraocular
tumors.

7. 2ry Open Angle
Subdivided on the basis of the site of aqueous
outflow obstruction.
Pre-trabecular
glaucoma
Trabecular
Post-
trabecular

8. 1) Pre-trabecular glaucoma:
in which aqueous outflow is obstructed by
a membrane covering the trabeculum,
which may consist of:
- Fibrovascular tissue (e.g. early
neovascular glaucoma).
- Endothelial cells (e.g. iridocorneal
endothelial syndrome).

9. 2) Trabecular glaucoma:
in which the obstruction occurs as a result of:
a) Clogging up of the meshwork by:
- Pigment particles (e.g. pigmentary glaucoma).
- Red blood cells (e.g. red cell glaucoma).
- Degenerated red cells (e.g. ghost cell glaucoma).
- Macrophages and lens proteins (e.g. phacolytic
glaucoma).
- Proteins (e.g. hypertensive uveitis).
- Pseudoexfoliative material.
b) Alteration of the trabecular fibers themselves
by:
- Edema (e.g. herpes zoster iritis).
- Scarring (e.g. post-traumatic angle recession
glaucoma).

10. 3) Post-trabecular glaucoma
Aqueous outflow is impaired as a result
of elevated episcleral venous pressure
due to:
- Carotid-cavernous fistula.
- Obstruction of the superior vena cava.

11. Important types
of
Secondary
Glaucoma

12. Pseudoexofoliation Glaucoma
- Pseudoexofoliation (PEX) syndrome:
characterized by deposition of grey-white,
fibrillogranular material in the anterior lens
capsule, zonules, ciliary body,
iris, trabeculum,
anterior vitreous face and conjunctiva.
- Pseudoexofoliation glaucoma occurs when
trabecular block occur by clogging up of the
trabeculum by Pseudoexofoliation material

13. Pseudoexofoliation Glaucoma
Clinical picture:
1) Cornea: PEX materials on the posterior
surface.
2) Iris: Atrophy – PEX material.
3) Lens: PEX materials forming central disc and
peripheral band – cataract – subluxation.
4) Gonioscopy:Trabecular hyperpigmentation
and PEX materials.
Treatment: as POAG.

14. Neovascular Glaucoma
Retinal ischemia  vasoproliferative growth
factor  retinal neovascularization,
rubeosis iridis & neovascularization at the
angle of AC.
Causes:
1) Ischemic CRVO and CRAO.
2) PDR.
3) OLD RD.
4) IOTumors.

15. Neovascular Glaucoma: 3 stages
1) Rubeosis iridis: iris new vessles.
Treatment : Argon laser photocoagulation of the ischemic retina.
2) 2ry open angle glaucoma: due to neovascular membrane in
front of the trabeculum.
Treatment: 1) Medical: antiglaucoma – steroids – atropine.
2) Argon laser photocoagulation of the ischemic retina.
3) 2ry angle closure glaucoma: due to contraction of the
membrane.
Treatment:1) Argon laser photocoagulation of the ischemic retina.
2) Surgery: trabeculectomy with adjunctive Mitomycin C OR artificial
shunt.
3) Cyclodestruction: destruction of the ciliary processes by laser.

16. Lens induced
Glaucoma

17. A) Phacolytic Glaucma:
Hypermature cataract  lens proteins leak through
intact capsule  blockage of the trabeculum with
proteins and macrophages filled with proteins.
Clinical picture:
- Corneal edema.
- Deep AC with floating white particles
(pseudohypopyon).
- Gonioscopy: open angle.
Treatment:
- 1st : Control IOP medically.
- Then: cataract surgery.

18. B) Phacoanphylactic glaucoma:
Rupture of lens capsule  autoimmune
reaction to lens proteins  uveitis and
glaucoma.

19. C) Phacomorphic glaucoma :
Intumescent cataract (Swollen lens) 
pupillary block  iris bombe  angle
closure.
Treatment:
1) Control of IOP.
2) Cataract surgery.

20. Thank You
Hussein Bicar (1913-2002)