Jennifer O.

Asio, RN, MN
 An OPTIC neuropathy
characterized by optic disc cupping
and visual field loss.
It is usually associated with elevated
intraocular pressure.
 RISK FACTORS
-Adult-onset diabetes
- Age = > 40 y.o. - Myopia
- Race = African - Hypertension
American and Asian - Arteriosclerotic and
populations ischemic disease
- Gender = male - Migraine syndromes
- Family history - Eye trauma
- Prolonged use of
corticosteroid
- Emotional stress
 PATHOPHYSIOLOGY

OPEN ANGLE GLAUCOMA CLOSE ANGLE GLAUCOMA

Trabecular meshwork Iris is pushed
clogged against the lens

Fluid in anterior chamber of eye builds up

Increase pressure exerts force on optic nerve

 Consistent elevated pressure will be
relayed to the brain through the axons

Eventually axons die Immediate

and the optic nerve rise in
may collapse into IOP
an irregular shape
 Optic nerve Sudden optic
damage nerve damage

Loss of
Peripheral vision

Loss of central
vision

BLINDNESS
MANAGEMENT
GOAL: CONTROL IOP!!!
IN GENERAL, IF THE MECHANISM IS:
• OPEN-ANGLE
-PRIMARILY MEDICAL MGT
• ANGLE-CLOSURE
-PRIMARILY SURGICAL MGT
• (LASER VS. FILTERING)
• CONGENITAL
-PRIMARILY SURGICAL MGT
TREATMENT
PHARMACOLOGICAL
• Beta Blockers (Timolol, Betaxolol)
• Carbonic Anhydrase Inhibitor [CAI]
•Azetazolamide- Diamox
• Topical- Dorzolamide, Brinzolamide
• Alpha 2 Agonists
• Apraclonidine, Brimonidine
• Parasympathetic Drugs
• Prototype drug: PILOCARPINE
• Hypotensive Lipids
• Prostaglandin Analogues (Lantoprost,
Travoprost)
• Prostamides (Bimatoprost)
• Decosanoids (Unoprostone)
• Hyperosmotic Agents
• Mannitol, Oral Glycerin
 SURGICAL
MANAGEMENT
1.Laser
Trabeculoplasty
(Argon,
Diodide)
2.Iridotomy
3.Filtering
Procedures
4.Gonioplasty
Other OPTIONS TO REDUCE IOP:
•GLAUCOMA TUBE SHUNT SURGERY
•CILIARY BODY ABLATION
PROCEDURES
•CYCLODIALYSIS
•ENUCLEATION!!
Any OPACITY in the LENS
of the eye.
 CLASSIFICATION OF
CATARACT

A. MATURITY
A.1. IMMATURE
CATARACT
-only part of the
lens has opacified
A.2. MATURE
CATARACT
all of the lens
protein is
opaque
A.3. INTUMESCENT CATARACT
Lens has become swollen by
imbibed water
A. 4 HYPERMATURE CATARACT
– lens proteins have liquified
A.5. MORGAGNIAN – hypermature
cataract leading to total liquefaction
of the cortex making the nucleus sink
inferiorly
B. MORPHOLOGY
B.1. NUCLEAR Cataracts – central
opacity. Also known as nuclear
sclerosis
B.2. Capsular
–opacity in the
lens’ capsule

B.2.a. Anterior
Capsular
B.2.b. Posterior
Capsular
3. Cortical Cataracts
-These are wedge-shaped
opacities near the periphery of the
lens. Also called cortical spokes
or cuneiform opacities.
4. SUBCAPSULAR

4.a. Posterior
Subcapsular
Cataracts –
located in the
posterior cortical
layer and are
usually axial.
4.b. Anterior
Subcapsular
Cataracts
5. Lamellar – a
congenital
cataract that is
confined on the
vortex
c. Sutural Cataract - a congenital
cataract with opacities in the Y
nucleus of the fetal lens nucleus
C. Age of Onset
1. Senile - age related or
degenerative cataracts
2. Congenital – in born caused
by mother’s infection from
Rubella
3. Trauma – caused by mechanical
injury, physical forces, and
osmotic influences.
4. Drug – Induced Cataracts –
caused by long term use of
corticosteroids,phenothiazines
anticholinesterases,
Amiodarone .
5. Associated with other Ocular
disorders - such as uveitis,
retinitis pigmentosa,
essential iris atrophy,
chronic hypotony and
absolute glaucoma.
6. Others – malnutrition and
smoking
 PATHOPHYSIOLOGY
- PATHOGENESIS IS NOT
COMPLETELY UNDERSTOOD

- BIOCHEMICALLY, LENS PROTEINS

FORM AGGREGATES
 PREDISPOSING PRECIPITATING
FACTORS FACTORS

•Age: > 60 y.o. •Trauma

•Mother’s •Exposure to Rubella
during 1 st
exposure to
Rubella trimester of fetal

• Smoking •
life

• Heredity
Long term use of
Steroid
• DM •
Other ocular
disorders
 Predisposing Precipitating
factors factors

Migration of epithelial cells

Chemical Modification of lens proteins (Crystallins)

Progressive Pigmentation of the Aggregation of lens proteins into

lens high-molecular-weight proteins

Vesicle Formation between lens

fibers
Brown
Cataract Oxidative Damage S/Sx: fluctuation in
refractive index,
blurred vision under
bright light (opacity in
OPACITY OF the visual axis),
diplopia (opacity in the
THE LENS visual axis
DIAGNOSTIC EXAMINATION
•Direct Opthalmoscopy
•Slit-lamp Biomicroscopy
•Direct Fundus Examination
•Lacrimal Apparatus
Irrigation
 MANAGEMENT
INDICATED IN :
-PATIENTS WHO REFUSE SURGERY
-IMMATURE CATARACTS

USUALLY TAKE THE FORM OF:

-EYEGLASSES (BEST CORRECTABLE VISION)
-DILATING DROPS (TROPICAMIDE, ATROPINE)
SURGICAL MANAGEMENT
GOAL: REMOVE LENS AND REPLACE WITH
ARTIFICIAL (INTRA-OCULAR) LENS, OR IOL

A. EXTRACAPSULAR CATARACT
EXTRACTION WITH INTRA-OCULAR
LENS IMPLANTATION (ECCE W/ IOL)

B. SMALL-INCISION CATARACT SURGERY

WITH IOL (SICS)
C. PHACOEMULSIFICATION WITH IOL (PKE)
ECCE with IOL
B. SMALL INCISION CATARACT
SURGERY WITH IOL
C. PHACOEMULSIFICATION WITH IOL
 POST-OPERATIVE MANAGEMENT
- Activity restrictions

- GUARD against infection!

- Topical medications (Antibiotic +

Anti-inflammatory drugs)

- Regular follow-up post-op

ASSESSMENT
Symptoms:
- pain
- reduced vision
- photophobia
- eye secretions
- altered corneal light reflex
- patchy areas may be visible on
examination
THANK YOU!