GLAUCOMA

Diska Astarini I11109083

 Glaucoma is an optic neuropathy characterized by cupping of the optic disc and the loss of visual field. Associated to intraocular pressure (IOP) visual field sensitivity and eventually leads to blindness in the affected eye

 Worldwide, glaucoma is the leading cause of irreversible blindness Almost 60 millions people have Glaucoma. In fact, as many as 6 millions individuals are blind in both eyes from this disease

Pathophysiology
increased intraocular pressure (usually > 24 mmHg)
Overproduction of HA with normal Drainage block of fluid flow from posterior to anterior chamber reduced flow through the trabecular meshwork

Ischemic of Optical nerve Push Optical Nerve

Diffuse ganglional cell atrophy

Effect to the Vision

Risk Factors
Age Family History Drug consumption (steroid) Trauma Severe Hypermethrophya Other systemic disease (ex ; DM, Hypertension)

Sign and symptom

Symptoms may include: Blurred vision Severe eye pain Headache Rainbow haloes around lights Nausea and vomiting Elevated intraocular pressure Visual field loss Optic disk changes Enlargement of the eye.

Diagnosis
Measuring intra ocular pressure (tonometry); Inspecting the drainage angle of your eye (gonioscopy); Evaluating any optic nerve damage (ophthalmoscopy);

Testing the visual field of each eye (perimetry).

Classification
1. 2. 3. 4. Open Angle Glaucoma Angle closure glaucoma Congenital Glaucoma Secondary glaucoma Glaucoma can be divided roughly into two main categories, "open angle" and "closed angle glaucoma.

Types of glaukcoma
Types Chronic Open Angle Glaucoma Cause Gradual blockage of drainage channel Symptoms Pressure builds slowly Gradual loss of side vision Comment Affects side vision first This type of glaucoma progresses very slowly and is a lifelong condition. This condition constitutes a medical emergency, as permanent blindness occurs rapidly without immediate treatment.

Acute Closed Angle Glaucoma

Total blockage of drainage channel Sudden increase in pressure Nausea

Blurred vision Severe pain Halos around lights

Secondary Glaucoma Injury, infection, tumors, drugs, or inflammation cause scar tissue which blocks the drainage channel
Congenital Glaucoma Fluid drainage system abnormal at birth

Gradual loss of side vision Affects side vision first

This form of glaucoma may progress slowly, as in cases of chronic glaucoma.

Enlarged eyes Cloudy cornea Light sensitivity Excessive tearing ApaGrafix materials call 770-641-7310 - Atlanta GA USA

This condition must be treated soon after birth if vision is to be saved.

Examination Methods

Oblique Illumination of the Anterior Chamber

Slit-Lamp Examination

Gonioscopy
Gonioscopy can differentiate the following conditions:
Open angle: open angle glaucoma. Occluded angle: angle closure glaucoma. Angle access is narrowed: configuration with imminent risk angle of an acute closure glaucoma. Angle is occluded: secondary angle closure glaucoma, for example due to neovascularization in rubeosis iridis. Angle open but with inflammatory cellular deposits, erythrocytes, or pigment in the trabecular meshwork: secondary open angle glaucoma.

Measuring Intraocular Pressure

Applanation Tonometry

Optic Disk Ophthalmoscopy

Visual Field Testing

visual field testing can be grouped into several important categories: Confrontational Amsler grid Static perimetry Kinetic perimetry Frequency doubling analysis

Treatment
Principe: reducing IOP by decreasing aqueous production or increasing aqueous outflow Currently, the effectiveness of a medication in the treatment of glaucoma is measured by its ability to lower IOP Medical, surgical or laser

Medical Treatment
Suppression of Aqueous Production
Topical beta-adrenergic blocking agents, Apraclonidine, Brimonidine, Dorzolamide hydrochloride and brinzolamide, Carbonic anhydrase inhibitorsacetazolamide

Facilitation of Aqueous Outflow

The prostaglandin analogsbimatoprost 0.003%, latanoprost 0.005%, and travoprost 0.004% solutions, Parasympathomimetic agents Pilocarpine, Epinephrine, Dipivefrin

Reduction of Vitreous Volume

Hyperosmotic agents, Oral glycerin (glycerol)

Miotics, Mydriatics, and Cycloplegics

Surgical and laser treatment

Peripheral Iridotomy, Iridectomy, Iridoplasty Laser Trabeculoplasty Glaucoma Drainage Surgery and

Trabeculectomy Viscocanalostomy and deep sclerectomy with collagen implant Goniotomy

Cyclodestructive Procedures

OPEN ANGLE GLAUKOMA

OPEN ANGLE GLAUCOMA

Primary open-angle glaucoma (POAG), the most common form of glaucoma, accounts for 60 70% of all glaucomas and 9095% of primary glaucomas. POAG is a bilateral, chronic progressive condition that typically appears in individuals over 60 years of age
PRIMARY OPEN ANGLE GLAUCOMA

Groups at risk
Age : from the 40-49 age group into those aged over 80. ocular hypertension myopia

Signs
the optic disc changes. The cup to disc ratio increases. Asymmetry of disc cupping

Diagnostic considerations
Measurement of intraocular pressure Elevated intraocular pressure is an alarming sign Twenty-four-hour pressure curve Fluctuations in intraocular pressure of over 5 6 mmHg may occur over a 24-hour period. Gonioscopy Ophthalmoscopy

treatment
The goal is to maintain IOP less than 21 mmHg and continued visual field loss should be minimal. Various treatment modalities include medical treatment, laser therapy,and surgery. Patients will initially start with topical ocular drug therapy Prognosis : If discovered early and treated adequately, the prognosis for POAG is excellent

ACUTE ANGLE CLOSURE GLAUCOMA

Acute angle closure glaucoma

History The attack comes on quite quickly the intraocular pressure rises rapidly Red eye There is pain in one eye, can be extremely severe impaired vision and haloes around lights may have had similar attacks in the past may be systemically unwell, with severe headache, nausea, and vomiting

Risk factors
increasing age female gender family history of glaucoma South-East Asian, Chinese, or Inuit ethnic background.

Examination
The eye is inflamed and tender The cornea is hazy and the pupil is semidilated and fixed. Vision is impaired according to the state of the cornea On gentle palpation the eye feels harder than the other eye. The anterior chamber seems shallower than usual, with the iris being close to the cornea

Management
Urgent referral to hospital is required. intravenous acetazolamide 500 mg and pilocarpine 4% should be instilled in the eye to constrict the pupil (iridotomy) or surgically (iridectomy) to restore normal aqueous flow The other eye should be treated prophylactically in a similar way.

Aqueous Humor flow after iridectomy

Congenital Glaucoma
Primary congenital glaucoma Together with other anomaly

Primary Congenital Glaucoma

Present at birth; however, but its manifestations may not be recognized until infancy or early childhood Pathophysiology : Primary congenital glaucoma is restricted to a developmental abnormality that affects the trabecular meshwork Estimated to affect fewer than 0.05% of ophthalmic patients The disease is bilateral in approximately 75% of cases.

 Primary congenital glaucoma usually is diagnosed at birth or shortly thereafter, and most cases are diagnosed in the first year of life. Most cases oare sporadic in occurrence may be transmitted through an autosomal recessive pattern Male patients are found to have a higher incidence of the disease, comprising approximately 65% of cases.

Clinical
History Triad of manifestations : Epiphora Photophobia Blepharospasm

Secondary glaucoma

Secondary glaucoma
Inflammatory glaucoma
Uveitis of all types Fuchs heterochromic iridocyclitis

Traumatic glaucoma
Angle recession glaucoma: Traumatic recession on anterior chamber angle Postsurgical glaucoma Aphakic pupillary block Ciliary block glaucoma

Phacogenic glaucoma
Angle-closure glaucoma with mature cataract Phacoanaphylactic glaucoma secondary to rupture of lens capsule Phacolytic glaucoma due to phacotoxic meshwork blockage Subluxation of lens

Drug-induced glaucoma
Corticosteroid induced glaucoma Alpha-chymotrypsin glaucoma. Postoperative ocular hypertension from use of alpha chymotrypsin.

Glaucoma secondary to intraocular hemorrhage

Glaucoma of miscellaneous origin

Associated with intraocular tumors Associated with retinal detachments Secondary to severe chemical burns of the eye Associated with essential iris atrophy Toxic Glaucoma

Hyphema Hemolytic glaucoma, also known as erythroclastic glaucoma Neovascular glaucoma

Secondary glaucoma
is caused by: Drugs such as corticosteroids Eye diseases such as uveitis Systemic diseases Trauma Due to lens changes Post operative Raised episcleral venous pressure