Menjadi Program Studi Pendidikan Dokter (PSPD) Terkemuka

di Kawasan Indonesia Timur dengan Unggulan di Bidang

Kesehatan Pariwisata berlandaskan nilai-nilai
“Rahmatan Lil ‘Alamin”.

GLAUCOMA
I K N Geradanta
FAKULTAS KEDOKTERAN UNIVERSITAS ISLAM AL-AZHAR
2022
 CORE VALUE
“Educating the mind, without educating the
heart, is no education at all”
-Aristotle-
 Anatomical

Mechanism

Classification

Treatment
ANATOMY
AQUEOUS HUMOR FLOW

Ciliary body  Posterior chamber  Pupil  Anterior

chamber  Trabecular meshwork  Canal Schlemm 
vena system
DEFINITION
• Optic neuropathy characterized by :

• Optic disc cupping

• Visual Field Loss

Usually associated with elevated intraocular pressure

INTRAOCULAR PRESSURE (IOP)
• High IOP  ≥ 22 mmHg
• IOP Examination Method :

1. Digital 3.
2. Schiotz
Palpation Aplannation

4. Non contact
tonometer
MECHANISM
CLASSIFICATION
CLASSIFICATION
A. Primary Glaucoma
1. Primary Open Angle Glaucoma
2. Primary Angle Closure Glaucoma
 CLASSIFICATION
B. Secondary Glaucoma *
1. Secondary Open Angle Glaucoma
• Mature / hypermature cataract  Phacolytic glaucoma
• Infection  uveitis
• Drug-induced glaucoma (>>> corticosteroid)
• Neovascularization
2. Secondary Angle Closure Glaucoma
• Lens Dislocation
• Immature Cataract  Phacomorphic glaucoma
• Neovascularization
C. Childhood Glaucoma
• Onset

Acute

Chronic
ACUTE GLAUCOMA
CLINICAL MANIFESTATION

Symptoms (with attack):

1. Nausea and vomiting
2. Headache
3. Redness
4. Seeing “halo” or rainbow when see the light

Without attack there is no symptoms

CLINICAL MANIFESTATION
Sign:
1. IOP > 22 mmHg
2. Gonioscopy  closure angle
(Salmon JF, 2018. Glaucoma dalam Vaughan & Asbury’s General Ophthalmology. 19th ed) 6
CLINICAL MANIFESTATION
Sign:
CHRONIC GLAUCOMA
CHRONIC GLAUCOMA

Primary Open Secondary Open Angle

Glaucoma (SOAG)
Angle Glaucoma
• Lens-induced Glaucoma
(POAG) • Exfoliation Syndrome
Normal-tension • Uveitic Glaucoma
• Drug-induced Glaucoma
Glaucoma
CHRONIC GLAUCOMA

Primary Open Angle Glaucoma

(POAG)
Normal Tension Glaucoma
PRIMARY OPEN ANGLE GLAUCOMA

 The commonest form of glaucoma (in Caucassian & Afro-

Caribbean populations)
 Risk factors:
a. Elevated IOP
b. Age >40  increased incidence with age
c. Family History
 No sex predilection
CLINICAL MANIFESTATION

Symptoms :
1. Asymptomatic
2. Central vision lost  “tunnel vision”
CLINICAL MANIFESTATION
Sign:
1. IOP > 22 mmHg
2. Gonioscopy  open angle
CLINICAL MANIFESTATION

3. Perimetry  visual field defect

CLINICAL MANIFESTATION
4. Funduscopy / Indirect Ophthalmoscopy  Optic Disc Cupping
NORMAL TENSION GLAUCOMA
 Low-tension Glaucoma
 Progressive optic neuropathy similar to POAG
 No documented high IOP (> 22 mmHg)
 Risk Factors :
 Migraine, ischemic vascular disease &
autoimmune disease
 Clinical manifestation  = POAG
OCULAR HYPERTENSION
 High IOP, but with NORMAL Optic Nerve, NORMAL Visual
Field, and Gonioscopy.
 Work Up :
a. Visual Field
b. Central Corneal Thickness
c. Optic Coherence Tomography
CHRONIC GLAUCOMA

Secondary Open Angle Glaucoma (SOAG)

• Lens-induced Glaucoma
• Exfoliation Syndrome
• Uveitic Glaucoma
• Drug-induced Glaucoma
LENS-INDUCED GLAUCOMA

PHACOLYTIC GLAUCOMA
• Patogenesis :
Mature / hypermature
cataract  Leakage of lens
material through lens capsule
 obstruct trabecular
meshwork
• Symptom :
• Unilateral pain, ↓ visual acuity
• Signs :
- ↑ IOP, inflammation reaction
in Anterior Chamber
• Th/ : Lens Extraction
PSEUDOEXFOLIATION SYNDROME /
EXFOLIATIVE GLAUCOMA
PSEUDOEXFOLIATION (PXF)
• Patogenesis :
Unknown
• Clinical Findings :
• PXF material on lens
capsule & iris
• Phacodonesis
• Lens subluxation • Th/ :
• Exfoliative glaucoma   Argon Laser
High IOP Trabeculoplasty
 Trabeculectomy +/- Lens
extraction
DRUG-INDUCED GLAUCOMA

STEROID INDUCED GLAUCOMA

• Prolong use of topical, periocular, inhaled or
systemic corticosteroid
• Management:
 Stop steroid (if possible)
 Anti glaucoma medication
 Surgery : Trabeculectomy  if IOP
uncontrolled
CHILDHOOD GLAUCOMA
CLINICAL FEATURES
 Triad: epiphora, photophobia,
blepharospasm
 High IOP
 Reduced in visual acuity
 Buphthalmos
 Corneal enlargement (diameter >
12 mm)
 Corneal edema
 “Haab striae” : tears in descemet
membrane
 Glaucomatous cupping
TREATMENT
1. MEDICAL
Purpose :
• Decrease the production of aqueous humor (Beta-
blocker  Timol ed, carbonic anhydrase inhibitor 
Glaucon, alpha-1 agonist  Alphagan ed)
• or Increase the outflow (Prostaglandin analog 
Xalatan / travatan ed, miotic  Carpin)
62
63
2. LASER
3.SURGERY
- Trabeculectomy