GLAUCOMA

Dr. Wah Wah Lwin

Associate Professor
• Glaucoma is a progressive optic neuropathy with
characteristic changes in optic nerve head and
corresponding loss of visual field

• Raised IOP is most important risk factor

(Normal IOP = 11-21 mmHg)

• 2nd leading cause of blindness worldwide

Increasing optic disc cup
Progressive thinning of neuroretinal rim
Changes in optic nerve head
Lamellar Dot Sign
 Aqueous secretion and drainage
Aqueous is secreted from ciliary body and drains through the AC angle

Route of aqueous outflow

a. trabecular b. uveosclera c. iris
TYPES
According to with or without underlying disease
• Primary (no underlying eye disease)
• Secondary (with underlying eye disease)
Eg, LIG (lens induced glaucoma)
PDS (pigment dispersion syndrome)
NVG (neovascular glaucoma)
 TYPES
According to angle structure
• Open angle glaucoma
• Angle closure glaucoma
Ocular hypertension
• IOP> 21mmHg without detectable glaucomatous
changes on standard clinical tests

Normal tension glaucoma

• A mean IOP <21mmHg on diurnal testing.
Glaucomatous optic disc damage and visual field
loss and open drainage angle on gonioscopy,
absence of secondary causes for glaucomatous
optic disc damage
Primary open angle glaucoma
• Known as chronic simple glaucoma
• Affects both sex equally
• IOP >21mmHg
• Glaucomatous optic nerve damage
• An open normal appearing anterior chamber angle
• Characteristics visual field loss
• Absence of sign of secondary glaucoma or a non-
glaucomatous cause for optic neuropathy
Primary angle closure glaucoma (PACG)

Angle closure
- refers to occlusion of trabecular meshwork by the
peripheral iris obstructing the aqueous outflow.

- PACG – responsible for up to half of all cases of

glaucoma globally

- Anatomical predisposed eye – relatively anterior

location of the iris-lens diaphragm secondary to short
eyeball, shallow anterior chamber
Acute Angle Closure Glaucoma

• Is an ophthalmic emergency requiring urgent

treatment to prevent irreversible optic nerve
damage
Clinical Features
Symptoms
• Very severe pain (periocular, headache)
• Nausea, vomiting
• BOV
• Halos
Signs
• Red eye
• Raised IOP ( usu: 50-80mmHg)
• Cornea odema
• Angle closed
• Mid dilated pupil
• Glaukomflecken
• Contralateral eye- angle narrow, shallow Anterior
Chamber (AC)
a. Shallow AC
b. Glaukomflecken
c. Mid dilated pupil
 Treatment
Immediate treatment
-For reduction of IOP
• IV 20%mannitol 200ml within 20 mins or IV
Acetazolamide 500mg stat
• P.O Acetazolamide 250mg 4 times/day
• Topical Beta blocker BD
• Topical Pilocarpine 2% QID
• Contralateral eye – topical pilocapine 1% QID while
awaiting laser peripheral iridectomy (PI)

For reduction of congestion

• Topical steriod QID
Definitive treatment
• Bilateral laser PI or surgical PI

• Trabeculectomy with PI
Laser PI
THANK YOU