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15 - Glaucoma - Part 1
15 - Glaucoma - Part 1
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
2. Uveo-scleral pathway
choroid
Supra-choroidal space
Drains a small proportion of aqueous (4%). It drains it across the ciliary body into the supracoroidal space, and into the venous circulation across
Classification of Glaucoma:
1. Primary glaucoma: 1. Chronic open angle 2. Acute and chronic closed angle 2. Congenital glaucoma: 1. Primary 2. Rubella 3. Seconday to other inherited ocular disorders (e.g. an-iridia; absense of iris) 3. Secondary glaucoma (causes): 1. trauma 2. Ocular surgery 3. Associated with other ocular diseases (uveitis) 4. Raised episcleral venous pressure 5. Steroid induced
Primary Glaucoma:
Is the iris:
NOT covering the Trabecular meshwork Covering the Trabecular meshwork
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.
glaucoma It is the 3rd cause of blindness in the UK. It is also called chronic open angle glaucoma. It causes SLOW damage to the optic nerve, causing gradual loss o
As fluids accumulates in the anterior chamber due to decreased drainage, intra-ocular pressure increases and cases damage to the optic nerve.
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
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
Treatment: 1.Even though the IOP is normal but medication to decrease IOP as much as possible are used.
hyperopoia) with shallow anterior chambers. Normally there is some resistance between the pupil margin and the lens.
But sometimes.
1. The eyes becomes red and painful due to rapid increase in IOP.
Acute angle closure glaucoma may notice haloes (circles of (cont.): 3. Patient
light) around light due to dispersed light in waterlogged cornea.
Acute angle closure glaucoma have similar symptoms in They may (cont.):
the past that are aborted by going to sleep, because sleeping constricts the pupils pulling it from the lens.