GLAUCOMA

Glaucoma is characterized by chronic progressive optic nerve atrophy associated with visual field defects with or without raised intraocular pressure

ANGLE ANATOMY

Classification
Congenital Glaucoma Primary Glaucoma 1- Open angle 2- closed angle Secondary Glaucoma Absolute Glaucoma

Congenital
Features Buphthalmos
corneal diameter 12 mm < 1 yr

Tears of descemets membrane Corneal haze Increased A/C depth Optic disc cupping

Open Angle Glaucoma

Risk factors
HISTORY: Positive family history African American background History of trauma History of steroid use

EXAMINATION: C/D 0.6 or greater Vertical elongation of disc

Inf.

rim thinner than sup. asymmetry > 0.2

C/D

Primary Glaucoma
Primary open angle glaucoma

Features
Virtually symptom less frequent change of glasses gross field defect (late stages)

Diagnosis
Ophthalmic exam Field test

Optic Nerve

Normal Disc

Cupped Disc

Field Test

Humphery Field Trace

Narrow Angle Glaucoma

Onset: 50+ years of age

Symptoms Severe eye/headache pain Blurred vision Red eye Nausea and vomiting Halos around lights Intermittent eye ache at night

Signs Red, teary eye Corneal edema Closed angle Shallow AC Mid-dilated, fixed pupil Glaucomflecken Iris atrophy AC inflammation

Acute Glaucoma

GLAUCOMA
Tonometry

Applanation

Schiotz

GLAUCOMA
Goldmann applanation tonometer

GLAUCOMA
Tonopen

Secondary Glaucomas
Lens induced glaucoma phacomorphic phacolytic lens particle induced phacoanaphylactic phacogenic uveitis Trauma Inflammatory (Uveitis e.t.c.) Neovascular glaucoma Pseudoexfoliative

 Glaucoma associated with intra ocular tumours Pigmentary glaucoma krukenberg spindle sampaolesis line iris transillumination defects Ciliary block / malignant glaucoma Glaucoma associated with intraocular heamorrhages

Absolute Glaucoma
Blind Painful Treatment Enucleation Cyclocryotherapy , cyclodiathermy, cyclophotocoagulation Retrobulbar absolute alcohol inj

Treatment

Treatment
Medical Beta blockers (Timolol 0.25%,0.5% , betaxolol )- first drug of choice C.I in bronchial asthma Carbonic anhydraze inhibitors Acetozolamide and dorzolamide 2% Sympathomimetics Apraclonidine and brimonidine Parasympathomimetics (pilocarpine) Prostaglandin Derivatives latanoprost 0.005% , bimatoprost

Treatment
Surgical Goniotomy congenital Trabeculotomy for congenital glaucoma's Argon laser /diode laser trabeculoplasty Trabeculectomy for adult glaucoma's Implants for difficult non responsive Prophylactic peripheral iridotomy (PI)/iridectomy

 Iridectomy 4mm limbal incision given iris is prolapsed through the wound small full thickness iris piece excised by Deweckers forceps iris reposited wound closed Peripheral iridotomy using Nd-YAG laser

 Trabeculectomy partial thickness scleral flap raised excision of trabecular tissue peripheral iridectomy at 12 clock postion closure of scleral flap Sclerostomy viscocanalostomy