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Published by: Putu Yoana on Jun 20, 2013
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Dr. Nurfifi Arliani, SpM Fakultas Kedokteran UMY Yogyakarta


What is the Glaucoma ?
 Glaucoma

 diseases : elevated intraocular pressure  compression & atrophy N II & loss of visual field.
second caused of blindness in Indonesia

 The

How is the mechanism of Glaucoma? Immbalance between the production & out flow of aqueous humor Increase of intraocular pressure Compression of optic nerve Atrophy of optic nerve  Blindness .

Anatomy of the Eyeball .

Anatomy of the angle of the anterior chamber .


Hemodynamic of aqueous humor : aqueous humor is produced by ciliary body Outflow aqueous humor : 80% via Trabeculum meshwork 20 % uveoscleral pathway Outflow aqueous humor : Produced by ciliary body  COP  pupil  COA  Trabeculum meshwork  canalis Schlemm  plexus venosus subconjungtiva .

Intraocular pressure affected optic nerve .

Visual field of Glaucoma patient .

Classifications of Glaucoma  Primary open angle Glaucoma  Primary closure angle Glaucoma  Secondary open angle Glaucoma  Secondary closure angle Glaucoma  Congenital Glaucoma .

Blindness in the terminal stage .relentless bilateral chronic disease .Primary open angle Glaucoma The etiology: obstruction of the outflow of aqueous humor in the trabecular meshwork Symptoms: .unable to see the side few .good vision at the early stage .visual field defects .difficulty in activity .

6) Visual field defect / Scotoma IOP > 21 mmHg .PRIMARY OPEN ANGLE GLAUCOMA Sign : No symptom Excavated disk (CD > 0.

Visual field of the glaucoma patient .

Decrease the IOP with medications ± 20 – 50 % 2.THERAPY : 1. Routine visual field examination every 6-12 months 3. Filtering operation .

Nausea. prostrating pain that can radiate to the back of the head.PRIMARY ACUTE CLOSURE-ANGLE GLAUCOMA Red eye Decrease of visual acuity. See rainbow Painful of the eye. discomfort and fullness of the eye to a severe. vomiting .

pale) IOP >21 mmHg .PRIMARY ACUTE CLOSURE-ANGLE GLAUCOMA Palpebra spasme Conjungtiva hyperemia Cornea oedema Narrow of the Anterior chamber Pupil wide Lens cloudy Papil not specific (oedema.

Headache .

Red eye of Glaucoma .

Operasi (iridotomy/filtering) .Therapy. Evaluate iridocornea angle. Immediately decrease the IOP 3. open ? 4. Refer to hospital 2. 1.

SECONDARY GLAUCOMA  due to other disease SECONDARY OPEN ANGLE GLAUCOMA Uveitis Lens hipermatur Steroid Trauma Gejala: acute/chronic .

SECONDARY CLOSURE ANGLE GLAUCOMA Uveitis Lens Hypertrophy Tumor intraoculi Neovacularisasion angle Sign of closure angle glaucoma .

CONGENITAL GLAUCOMA New born Afraid of light hypersensitif Buphthalmos Cornea cloudy IOP >21 mmHg Out flow facility insufficient .

trabeculectomi Obat Short term . goniotomi 2.Therapy of Congenital Glaucoma: Operation: 1. trabeculotomi 3.

EARLY DETECTION Routine check-up Occure symptom Ophthalmologist .

Time of check-up ? (non glaucoma patient) 3 years : If any symptom of decreasing the visual acuity occure year If: Glaucoma family Steroid consumption Diabetes Hypertensi Ever had trauma Myop & hypermetrop high 1 .

Examination Optic Nerve IOP Out flow facility Ofthalmoscopi Tonometri Gonioskopi Visual field Perimetri .

Ofthalmoscopy Direct .

Tonometri Schiotz .

Tonometri Aplanasi .

Slit Lamp examination .

Visual field examination .


GLAUCOMA THERAPY Medicamentosa Aim: Operatif Decrease IOP Safe IOP How high ? .

Any other factor beside IOP 3. Continous Follow-up 4. Complication & Fund 5. with . The higher IOP. Remain good sight.Principles therapy of glaucoma: 1. the higher of the risk of damage risk 2.minor complication .affordable fund .

How to decrease IOP ? 1. Decrease the production of AH 2. Damage the Ciliary Body 4. Flow the AH to other place (filtering operation) . Increase the out flow of AH 3.

What will happen with the unobey patient? Recurrent IOP increase Severe damage of Optic Nerve Blindness .

Conclusion Damage of the nerve in glaucoma  The early detection is important since the damage is irreversible  Therapy by decreasing IOP into safe level  Obey the doctor suggest and disiplin with long-life medication may prevent of blindness  .


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