By: noor majeed rehani

Definition:group of diseases in which It is a heterogenous

damage to the optic nerve(optic neuropathy) is usually caused by raised ocular pressure (normal IOP is 15.5 mmHg) acting on the nerve head.range (11-21)

Basic physiology of aqueous humour:

1. Conventional pathway 2. Uveo-scleral pathway

LOP: Depends on the balance between production and removal of aqueous humour

1. Conventional Pathway:

Aqueous humour is secreted by the ciliary processes in the posterior chamber. Then it passes through the pupil into the anterior chamber. It is drained in posterior chamber through the Trabecular meshwork, Schlemms canal, and episcleral veins.

2. Uveo-scleral pathway
choroid

Supra-choroidal space

Drains a small proportion of aqueous (4%). It drains it across the ciliary body into the supra-coroidal space, and into the venous circulation across the sclera.

Mechanism of Optic nerve fiber damage

Mechanical damageTo optic nerve axons by the raised

IOP
Ischemia of nerve fibers caused by impaired perfusion

pressure (reducing blood flow at optic nerve head)

Classification of Glaucoma:
1.
1.

Primary glaucoma:
2.

Chronic open angle Acute and chronic closed angle

2.
1. 2.

Congenital glaucoma:
Primary Rubella Seconday to other inherited ocular disorders (e.g. aniridia; absense of iris)

3.

3.
1.

Secondary glaucoma (causes):

2.
3. 4. 5.

trauma Ocular surgery Associated with other ocular diseases (uveitis) Raised episcleral venous pressure Steroid induced

Primary Glaucoma:
NOT covering the Trabecular meshwork

Is the iris:
Covering the Trabecular meshwork

OPEN angle glaucoma

CLOSED angle glaucoma

Primary OPEN angle glaucoma

Pathogenesis:
Resistance of drainage of aqueous through the

Trabecular meshwok, due to: 1. Thickening of Trabecular lamellae (reduces pore size). 2. Reduction in number of lining Trabecular cells. 3. Increased extracellular material in the Trabecular meshwork spaces.

Open irido-corneal angle

(Trabecular meshwork is not covered)

Primary OPEN angle glaucoma:

It is also called chronic open angle

It is the most common type of glaucoma

It is the 3rd cause of blindness in the UK.

glaucoma. It causes SLOW damage to the optic nerve, causing gradual loss of vision.

 The patient first loses the peripheral visual field

then it progress to total blindness if left untreated.

As fluids accumulates in the anterior chamber due to decreased drainage, intra-ocular pressure increases and cases damage to the optic nerve.

Primary OPEN angle glaucoma (cont.)Symptoms:

Because the vision loss is gradual, the patient usually present when severe damage has occurred. 2. Most patients are detected by optometrist routine examination. Risk groups: 1. Affects 1 in 200 of population over the age of 40. 2. Males and females are equally affected. 3. The prevalence increase with age to nearly 10% in the over 80 population. 4. There maybe family history but the exact mode of inheritance is not clear.
1.

Normal tension glaucoma:

Some open angle glaucoma have normal intra-ocular

pressure called low-tension or normal-tension glaucoma.(glucomatous change) In these cases, there will be damage to the optic nerve even though the intra-ocular pressure is within normal range. The eyes of the normal tension glaucoma have normal angles, so its features are similar to that of primary open angle glaucoma. The causes of normal tension glaucoma is still unknown. The optic nerve is susceptible to damage even from normal IOP. Normal-tension glaucoma is thought to be related, at least in part, to poor blood flow to the optic nerve.

Normal tension glaucoma (cont.):

Risk factors:

Family history of glaucoma. 2. Cardiovascular diseases.

1.

Treatment: 1. Even though the IOP is normal but medication to decrease IOP as much as possible are used.

Acute angle closure glaucoma:

The condition occurs in small eyes (as in hyperopoia)

with shallow anterior chambers. Normally there is some resistance between the pupil margin and the lens.
But sometimes.

Acute angle closure glaucoma (cont.):

Sometimes when the iris is dilated, the lens sticks to the back of the iris causing obstruction of fluid flow from posterior to anterior chambers.
Fluid will accumulate behind the iris and pushes it on to the Trabecular meshwork preventing drainage of aqueous from the eye. This causes rapid increase in IOP.

Acute angle closure glaucoma (cont.):

Symptoms:

1. The eyes becomes red and painful due to rapid increase in IOP.

Acute angle closure glaucoma (cont.):

2. Blurred vision; because the cornea becomes edematous.

Acute angle closure glaucoma (cont.): 3. Patient may notice haloes (circles of light)
around light due to dispersed light in waterlogged cornea.

Acute angle closure glaucoma (cont.): may have similar symptoms in the past They
that are aborted by going to sleep, because sleeping constricts the pupils pulling it from the lens.

End of first part.