YEDTEPE NVERSTES

GZ HASTANES

GLAUCOMA
Ilgaz S. YALVA; MD
YEDTEPE NVERSTES
GZ HASTANES

Terminology
Glauko!
S"arkling il#er glare
Grey$Green %olor
Glau%oi! &i""o%ra'e
Dimne o( #iion
)arau!
YEDTEPE NVERSTES
GZ HASTANES

De*ni'ion
Glau%oma i a "rogrei#e+
#iion$',rea'ening -ieae
%,ara%'erize- .y o"'i%
neuro"a',y
/. 0le#a'e- In'rao%ular 1reure
2. O"'i% 3er#e 04%a#a'ion
5. Viual 6iel- Lo
YEDTEPE NVERSTES
GZ HASTANES

A7ueou In8o9 an- Ou'8o9
YEDTEPE NVERSTES
GZ HASTANES

A7ueou &umor 1ro-u%'ion
Clear 8ui-
Main'ain
#olume
IO1
3u'ri'ion (or
a#a%ular
o%ular 'iue
O"'i%al role
YEDTEPE NVERSTES
GZ HASTANES

3on$
"igmen'e-
0"i',elium
1igmen'e-
0"i',elium
A7ueou &umor 1ro-u%'ion
Inner non$"igmen'e- e"i',elium i
',e i'e o( a7ueou ,umor
"ro-u%'ion
2$5 :l;min
YEDTEPE NVERSTES
GZ HASTANES

S<k<
.a=lan'<lar
Mi'okon-ri
3>kleu
A7ueou &umor 1ro-u%'ion
A%'i#e Tran"or' ?Car.oni% An,y-rae
II@
Ul'ra*l'ra'ion
DiAuion
YEDTEPE NVERSTES
GZ HASTANES

A7ueou &umor Ou'8o9
Tra.e%ular
me,9ork ?BCD@
U#eo%leral
me,9ork ?/CD@
Trabecular
Outfow
Uveoscleral
Outfow
YEDTEPE NVERSTES
GZ HASTANES

Tra.e%ular Ou'8o9
6rom Tra.e%ular
Me,9ork
To S%,lemmE
Canal
Uveal meshwork
Corneoscleral meshwork
Juxtacanalicular meshwork
Schlemms canal
Collector canal
Scleral spur
Ciliary muscle
Iris
YEDTEPE NVERSTES
GZ HASTANES

Tra.e%ular Me,9ork
I' i a ie#e$like 'ru%'ure
YEDTEPE NVERSTES
GZ HASTANES

Eritrocytes
Giant vacuoles
pores
pores
pores
pores
Giant vacuoles
S%,lemmE Canal
YEDTEPE NVERSTES
GZ HASTANES

A
q
u
a
e
o
u
s

v
e
i
n
s
I
n
t
r
a
s
c
l
e
r
a
l

V
e
n
o
u
s

P
l
e
k
s
u
s

&

d
e
e
p

s
c
l
e
r
a
l

P
l
e
k
s
u
s
I
n
t
e
r
n
a
l

C
o
l
l
e
c
o
t

C
h
a
n
n
e
l
s
S
c
h
l
e

!
s

c
a
n
a
l
A7ueou Vein
YEDTEPE NVERSTES
GZ HASTANES

U#eo%leral Ou'8o9
Schle!s canal
Cornea
Collector channels
Intrascleral veins
Sclera
Ciliar" uscle
Uveoscleral
outfow
Trabecular
outfow
Ir< Foo'
Ciliary Mu%le
Su"ra%,oroi-al S"a%e
S%lera
Or.i'al #enou -rainage
YEDTEPE NVERSTES
GZ HASTANES

In'rao%ular 1reure
T,e ra'e o( a7ueou ,umor
"ro-u%'ion .y %iliary .o-y
Fei'an%e 'o a7ueou ,umor
ou'8o9 a%ro ',e 'ra.e%ular
me,9ork$S%,lemmE %anal y'em
T,e le#el o( e"i%leral #enou
"reure
YEDTEPE NVERSTES
GZ HASTANES

In'rao%ular 1reure
T,ere i a -eli%a'e .alan%e .e'9en
in8o9 an- ou'8o9 o( a7ueou ,umor
Gol-mann 07ua'ion
6G 6lo9 Fa'e o( a7ueou (orma'ion
CG 6a%ili'y o( 'ra.e%uler ou'8o9
"#G 0"i%leral #enou "reure ?H$/C mm
&g@
IO1G

6
C
I"#
YEDTEPE NVERSTES
GZ HASTANES

In'rao%ular 1reure
3ormal IO1 /J.HK2.L mm &g
?/C M 2/ mm &g@
#e"dhecker $ et al% &lin 'bl Au(enheilk )**+,,-.)/01
YEDTEPE NVERSTES
GZ HASTANES

In'rao%ular 1reure
3ormal -iurnal 6lu%'ua'ionG 5$L mm &g
3ormal
Glau%oma
YEDTEPE NVERSTES
GZ HASTANES

Digi'al IO1 0'ima'ion
YEDTEPE NVERSTES
GZ HASTANES

S%,iN'z Tonome'er
In-en'a'ion
YEDTEPE NVERSTES
GZ HASTANES

In'rao%ular 1reure
1reureG
6or%e
Area
YEDTEPE NVERSTES
GZ HASTANES

Gol-mann Tonome'er
1ro.e 5.CL mm -iame'er
Area O.5J mm
2
YEDTEPE NVERSTES
GZ HASTANES

Gol-mann Tonome'er
YEDTEPE NVERSTES
GZ HASTANES

3on$Con'a%' Tonome'er
A""lana'ion
YEDTEPE NVERSTES
GZ HASTANES

Tono"en
A""lana'ion
YEDTEPE NVERSTES
GZ HASTANES

1a%al Tonome'er
YEDTEPE NVERSTES
GZ HASTANES

O%ular Fe"one Analyzer
YEDTEPE NVERSTES
GZ HASTANES

Gonio%o"y
Un-er normal %on-i'ion ',e an'erior
%,am.er angle %an
no' .e #ie9e- -ire%'ly
Pe%aue ',e
lig,' %oming
(rom ',e angle
un-ergoe
!'o'al in'ernal re8e%'ion!
YEDTEPE NVERSTES
GZ HASTANES

Gol-mann len
JBQ gonio%o"y
LOQ e7ua'or$ora erra'a
O5Q e7ua'or$5CQ "eri",ery
YEDTEPE NVERSTES
GZ HASTANES

Gonio%o"y
S%,9al.e line
Tra.e%ular me,9ork
S%,lemmE %anal
S%leral "ur
Iri "ro%ee
YEDTEPE NVERSTES
GZ HASTANES

Gonio%o"y Angle Gra-ing
Gra-e RG 5JQ$RJQ Cor"u iliare ?Si-e O"en@
Gra-e 5G 2CQ$5JQ S%leral "ur ?O"en@
Gra-e 2G 2CQ Tra.e%ular me,9ork
?3arro9 @
Gra-e /G /CQ S%,9al.e line ?Cloe-@
Cloe- angleG CQ+ no #ii.le angle 'ru%'ure
YEDTEPE NVERSTES
GZ HASTANES

Gonio%o"y
S%,9al.e
line
1AS
S%leral "ur
Tra.e%ulum
1AS
1AS
S%,9al.e
line
YEDTEPE NVERSTES
GZ HASTANES

3ormal O"'i% Di%
/.2 million a4on
Diame'er /.OC 4 /.HJ mm
Ver'i%ally o#al
YEDTEPE NVERSTES
GZ HASTANES

3ormal O"'i% Di% Cu""ing
3ormal C;D C.5
C;D aime'ry .e'9een ',e eyeTC.2
YEDTEPE NVERSTES
GZ HASTANES

Glau%oma'ou O"'i% Di%
Sele%'i#e a4onal lo
Lamina %ri.roa .o9ing
O"'i% ner#e ,ea- %u""ing
YEDTEPE NVERSTES
GZ HASTANES

Glau%oma'ou O"'i% Di%
YEDTEPE NVERSTES
GZ HASTANES

Glau%oma'ou O"'i% Di%
Cu""ing
YEDTEPE NVERSTES
GZ HASTANES

Glau%oma'ou O"'i% Di%
O"'ik -ik Uukurlu=u #e nVral ,alka
C;D enlargemen'
Aime'ry
Laminar -o' ign
YEDTEPE NVERSTES
GZ HASTANES

Glau%oma'ou O"'i% Di%
3aal -i"la%emen' o( ',e #eel
YEDTEPE NVERSTES
GZ HASTANES

Glau%oma'ou O"'i% Di%
Paring o( ',e %ir%umlinear #eel
Payone''ing ign
YEDTEPE NVERSTES
GZ HASTANES

Glau%oma'ou O"'i% Di%
DiAue %u" enlargemen'
6o%al no'%,
YEDTEPE NVERSTES
GZ HASTANES

Glau%oma'ou O"'i% Di%
YEDTEPE NVERSTES
GZ HASTANES

Glau%oma'ou O"'i% Di%
S"lin'er ,emorr,age
YEDTEPE NVERSTES
GZ HASTANES

Glau%oma'ou O"'i% Di%
3er#e *.er layer lo
YEDTEPE NVERSTES
GZ HASTANES

Fe'inal 3er#e 6i.er Layer
o"'ik
-ik
6o#ea &orizon'al ra",e
3aal *.err
Ar%ua'e *.er
Ma%ulo"a"iller *.er
YEDTEPE NVERSTES
GZ HASTANES

Ilan- o( Viion in a Sea o(
Darkne!
3ormal #iual *el-
YEDTEPE NVERSTES
GZ HASTANES

Perimetry refers to the clinical assesment of the visual field
1erime'ry
YEDTEPE NVERSTES
GZ HASTANES

Glao%oma'ou Viual 6iel-
Lo
T,e main -e(e%' o( glau%oma i ',e ner#e *.er .un-le
-e(e%' ',a' reul' (rom -amage a' ',e o"'i% ner#e ,ea-.
T,e "a''ern o( ner#e *.er in re'inal area er#e- .y ',e
-amage- ner#e *.er .un-le 9i', %orre"on- 'o ',e
"e%i*% -e(e%'.
O"'i% ner#e A4on
Ganglion
%ell
Glau%oma'ou
-e(e%'
YEDTEPE NVERSTES
GZ HASTANES

Glao%oma'ou Viual 6iel-
Lo
YEDTEPE NVERSTES
GZ HASTANES

Su"erior Ar%ua'e De(e%'
YEDTEPE NVERSTES
GZ HASTANES

In(erior Ar%ua'e De(e%'
YEDTEPE NVERSTES
GZ HASTANES

Terminal Glau%oma
YEDTEPE NVERSTES
GZ HASTANES

Terminal Glau%oma
YEDTEPE NVERSTES
GZ HASTANES

S%anning laer o",',almo%o"y "i%'ure 'o
moni'or -i% %,angeG ,o9 "rogrei#e
-i% %u""ing
&ei-el.erg Fe'inal
Tomogra",y
YEDTEPE NVERSTES
GZ HASTANES

O"'i%al Co,eren%e Tomogra",y
YEDTEPE NVERSTES
GZ HASTANES

Clini%al Ty"e o( Glau%oma
1rimary o"en$angle
Glau%oma
3ormal "reure Glau%oma
A%u'e angle$%loure
Glau%oma
Se%on-ary Glau%oma
Congeni'al Glau%oma
YEDTEPE NVERSTES
GZ HASTANES

1rimary o"en$angle Glau%oma
A-ul' one'
IO1W2/ mm &g
O"en angle (orma'ion
Glau%oma'ou o"'i% ner#e ,ea-
-amage
Viual *el- lo
YEDTEPE NVERSTES
GZ HASTANES

O%ular &y"er'enion
IO1W2/ mm &g
O"en angle (orma'ion
3ormal o"'i% -i% *n-ing
3ormal #iual *el- e4amina'ion
YEDTEPE NVERSTES
GZ HASTANES

Cen'ral Corneal T,i%kne
3ormal CCT JRRK5R :m
T,in %ornea lo9 IO1
T,i%k %ornea ,ig, IO1
YEDTEPE NVERSTES
GZ HASTANES

1rimary O"en$Angle Glau%oma
Common 'y"e o( glau%oma
Gene'i% "re-i"oi'ion ?mul'i(a%'orial
in,eri'an%e@
Uually aym"'oma'i% un'il igni*%an'
lo o( #iual *el- ,a o%%ure-
La'e ",ae Tunnel #iion! an-
.lin-ne!
YEDTEPE NVERSTES
GZ HASTANES

3ormal 1reure Glau%oma
Very rare ?C.2D@
Similar 'o "rimary o"en angle
glau%oma
Pu' IO1 T2/ mm&g
Lo9 "er(uion "reure o( ',e o"'i%
ner#e
YEDTEPE NVERSTES
GZ HASTANES

3ormal 1reure Glau%oma
DiAeren'ial Diagnoi

Com"rei#e o"'i% ner#e "a',ology

C,iamal leion

Congeni'al o"'i% -i% a.normali'ie

I%,emi% o"'i% neuro"',y

Caro'i- i%,emia
YEDTEPE NVERSTES
GZ HASTANES

A%u'e Angle$Cloure Glau%oma
Le %ommon ?JD@
Ol-er
&y"erme'ro"i% eye
Caue o( Fe- 0ye!
20 !arrow
an"le
#$ %ide an"le
YEDTEPE NVERSTES
GZ HASTANES

A%u'e Angle$Cloure Glau%oma
Sym"'om
Su--en one' o( "ain(ul re- eye!
Plurre- #iion
&alo aroun- ',e lig,'
&ea-a%,e
3aue an- #omi''ing
YEDTEPE NVERSTES
GZ HASTANES

A%u'e Angle$Cloure Glau%oma
Sign
Fe-u%e- #iual a%ui'y
Fe- eye
&azy %ornea
Corneal e-ema
Ver'i%ally mi-$-ila'e-
*4e- "u"illa
Very ,ig, IO1
Cloe- iri-o%orneal angle on
gonio%o"y
YEDTEPE NVERSTES
GZ HASTANES

Congeni'al Glau%oma
O%%ur in in(an%y
Pu",',almo PullE eye!
YEDTEPE NVERSTES
GZ HASTANES

Congeni'al Glau%oma
D/C$2C Au'oomal re%ei#e
"ene'ran%e
Sa'ering+ 1,o'o",o.i% eye!
0"i",ora+ .le",aro"am+
",o'o",o.y
YEDTEPE NVERSTES
GZ HASTANES

Congeni'al Glau%oma
Larger myo"i% eye
Diame'er o( %ornea 9i-er ',an
normal
Fe-u%e- #iion
YEDTEPE NVERSTES
GZ HASTANES

Congeni'al Glau%oma
Clou-ing o( %ornea
Linear 'ear in De%emen' mem.rane
YEDTEPE NVERSTES
GZ HASTANES

Se%on-ary Glau%oma
1eu-oe4(olia'i#e Glau%oam
3eo#a%ular Glau%oma
1igmen'ary Glau%oma
Se%on-ary 'o Len
Se%on-ary 'o O%ular In8amma'ion
O%ular Trauma
O%ular Tumor
S'eroi- In-u%e- Glau%oma
YEDTEPE NVERSTES
GZ HASTANES

Se%on-ary Glau%oma
1eu-oe4(olia'ion Glau%oma
A grey$9,i'e
*.rillary ma'erial
-e"oi'ion
$Angle
$Len %a"ule
$ 1u"illary .or-er
$Ciliary 0"i',el
YEDTEPE NVERSTES
GZ HASTANES

Se%on-ary Glau%oma
3eo#a%ular Glau%oma
Caue- .y %,roni%
re'inal i%,emia
$Dia.e'e Melli'u
$Cen'ral re'inal
#ein o%%luion
$In'rao%ular 'umor
$U#ei'i
$Caro'i- O.'ru%'i#e
-ieae
YEDTEPE NVERSTES
GZ HASTANES

&opical Prosta"landin
'nalo"ues
&opical Prosta"landin
'nalo"ues
Car(onic 'nhydrase
Inhi(itors
Car(onic 'nhydrase
Inhi(itors
)eta )lockers )eta )lockers
'lpha*2 a"onists 'lpha*2 a"onists
Timolol /BOH
Dorzolami-e /BBJ
Prinzolami-e /BBH
Primoni-ine /BBL
Uno"ro'one /BBR
La'ano"ro' /BBO
Tra#o"o' 2CC/
Pima'o"ro' 2CC/


Me-i%al Trea'men' o(
Glau%oma
Parasympathometics Parasympathometics
1ilo%ar"ine
YEDTEPE NVERSTES
GZ HASTANES

To"i%al Pe'a$Plo%ker
De%reae
A7ueou &umor
Se%re'ion
24/
YEDTEPE NVERSTES
GZ HASTANES

To"i%al Pe'a$Plo%ker
3on$Sele%'i#e
Timolol Malea'e Timo"'i%
X
Timo"'i% Y0
X
Le#o.unolol Pe'agan
X
Car'eolol &y-ro%,lori-eCar'eol
X
Pe'a$/ Sele%'i#e
Pe'a4olol Pe'o"'i%
X
Pe'o"'i%$S
X
YEDTEPE NVERSTES
GZ HASTANES

Car.oni% An,y-rae
In,i.i'or
Sy'emi%
A%e'azolami-e 2JC mg '.
R4/ or R4/;2
To"i%al
Dorzolami-e &y-ro%lori-e
olu'ion 2D
Prinzolami-e &y-ro%lori-e
u"enion /D
&ig,ly ele%'i#e CAI$II
54/
Carbonic
Anhydrase
HCO
3
Na
+
Fluid Flow
YEDTEPE NVERSTES
GZ HASTANES

To"i%al 1araym"a',ome'i%
1ilo%ar"ine 2D+ RD
Con'ra%'ion %iliary mu%le
Mioi
A%%omo-a'ion
A%u'e angle %loure glau%oma R4/
YEDTEPE NVERSTES
GZ HASTANES

To"i%al Al",a$2 Agoni'
Primoni-ine 'ar'ra'e olu'ion C.2D 24/
A7ueou &umour "ro-u%'ion
YEDTEPE NVERSTES
GZ HASTANES

To"i%al 1ro'aglan-in
Analogue
1G 62al",a -eri#a'e
0n,an%e u#eo%leral ou'8o9
$La'ano"ro'
$Tra#o"ro'
$Pima'o"ro'
/4/ nig,' -oing
Trabecular
Outflow
Uveoscleral
Outflow
YEDTEPE NVERSTES
GZ HASTANES

&y"eromo'i% Agen'
Lo9er IO1 .y in%raeing .loo-
omolari'y .y %rea'ing an omo'i%
gra-ien' .e'9een .loo- an- #i'reou
o ',a' 9a'er i -ra9n (rom #i'reou.
Tem"orary IO1 re-u%'ion
Manni'ol IV 2CD olu'ion ?Jml;kg@
Ioor.i-e oral JCD olu'ion
Gly%erol oral JCD olu'ion
YEDTEPE NVERSTES
GZ HASTANES

Laer Tra.e%ulo"la'y
YEDTEPE NVERSTES
GZ HASTANES

Laer Iri-o'omy
YEDTEPE NVERSTES
GZ HASTANES

Laer Cy%lo",o'o%oagula'ion
04'ernal
Dio-e Laer
H/C nm
G$1ro.e
YEDTEPE NVERSTES
GZ HASTANES

Laer Cy%lo",o'o%oagula'ion
In'ernal -io-e laer
YEDTEPE NVERSTES
GZ HASTANES

Tra.e%ule%'omy
YEDTEPE NVERSTES
GZ HASTANES

3on$1ene'ra'ing Surgery
YEDTEPE NVERSTES
GZ HASTANES

Tu.e Im"lan'a'ion
YEDTEPE NVERSTES
GZ HASTANES

Gonio'omy
Congeni'al glau%oma
YEDTEPE NVERSTES
GZ HASTANES

Tra.e%ulo'omy
Congeni'al glau%oma