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The mouth is an opening on lower part of the human face used for taking in food, making sounds
and speech. On the outer part of the mouth are two lips (the upper and the lower). On both sides
of the mouth are the cheeks. The inside of the mouth consists of the tongue and the teeth.

The Lips
The lips form the outer border and opening of the mouth and are used to hold food in the mouth
and to form words during speech. They are used to form facial expression (such as smiling,
frowning, yawning and whistling).
The Cheeks
The cheeks form the sides of the mouth. They also assist in holding food in the mouth, chewing
and making speech.
The Palate
The roof of the mouth is called the palate. It separates the mouth from the nasal passage. The
front part of the palate is called the hard palatewhile the back part is called the soft palate. The
palate prevents food from getting to the nasal passage.
The Tongue
It a muscular tissue, flexible used for eating/chewing, swallowing and talking/making speech and
other sounds. The tongue also contains taste buds responsible for the sense of taste.
The Teeth
They are found in front the roof and the floor of the mouth and are used for biting and chewing
food. They also give the month its shape.
The Floor
The tongue is attached to the floor of the mouth except at the front where it is freely mobile.
The Gum
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The gum is also referred to as the gingival. It covers the jaw bones and supports the teeth in the
bones. It is pink in colour in health state but may be brown in dark skinned healthy individuals.
The part of the gum in-between the tooth is called the gingival papilla.
The Salivary Glands
There are three pairs of salivary glands - the sublingual, sub-mandibular and parotid glands
which open into the oral cavity. These glands secrete watery fluid called saliva which lubricates
the food and contains enzymes which help in food digestion. It also contains minerals and
proteins that protect the teeth.
Blood Supply and Venous Drainage
The mouth and the contents are supplied with oxygenated blood via the lingual, facial, palatine
arteries. The venous drainage is also along corresponding veins.
Nerve Supply
These are the lingual nerve, facial nerve, inferior alveolar nerve and their branches.

The Teeth
The teeth are located in the gum and jaw in the floor; and the roof of the mouth through their
roots.
Types of Teeth
Incisors
They are located in the front part of the mouth. They are fan-shaped and majorly used for cutting
food. The upper ones are bigger than the lower ones.
Canines
They are pointed teeth at the corner of the lips, strong and used for tearing food.
Premolars
They resemble the molars except that they are smaller. They have a narrow table surface with
two projections.
Molars
They are large and at the back of the mouth. They have a wide table surface and three
projections. They are used in grinding food.
Structure of the Teeth
Teeth are hard and bony structures in the mouths. They are the hardest and most durable organ.
Teeth have been found to be preserved long after the flesh and bones have decayed. They are
invaluable in phoresy. The tooth consists of several layers of tissue. The outermost part which is
the hardest part is called the enamel. The enamel, about 16mm thick is the visible part of the
teeth seen above the gum. It protects the other inner layers from bacteria and changes in the
temperature from hot and cold food. Directly under the enamel is another bone-like layer called
the dentin. It is also harder than the bone.
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The core of the tooth is known as the pulp which is in turn protected by the dentin. The pulp
contains the blood vessels which carry oxygen and nutrients to the tooth and also contain the
nerves which transmit pain and temperature sensation to the brain. The part of the tooth that is
visible is the crown while the portion that lies beneath the gum is the root. There is a hard tissue
know as the cementum surrounding the tooth root made up of a thin layer of bony tissue that
covers the dentin from the root to the neck of the tooth. There are tough tissues that help to hold
the tooth root in place and cushion the tooth against the gum and the jaw called the periodontal
ligament.
Types of Dentition
Two sets of teeth erupt during a man’s life time: These are:
1. Primary Dentition or Milk Dentition
They develop from between 6 months and 2½ years of age. The complete set is made up of about
20 teeth (5 in each quadrant - 2 incisors, 1 canine and 2 molars). They are usually smaller,
whiter, more rounded than the permanent teeth.
2. Secondary Dentition or Permanent Dentition
As described in arrangement below.

Arrangement of the Teeth

There are 32 permanent teeth in human (adult) equally distributed on the
4 dental arches (upper left; lower left; upper right and lower right). Eight teeth are found on each
of the dental arches. There are 4 different types of teeth with different shape and functions. These
are the incisors (2),
canine (1), premolars (2) and molars (3).
3. 2. 1. 2. 2. 1. 2. 3
3. 2. 1. 2. 2. 1. 2. 3

Development of the Teeth

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Humans are diphyodont—that is, they develop two sets of teeth during their lives.
The first set of teeth is the deciduous teeth, these are 20 small teeth also known as baby teeth or
milk teeth. Deciduous teeth start developing about two months after conception and typically
begin to erupt above the gum-line when a baby is between 5 and 7 months old. Occasionallya
baby may be born with one or more deciduous teeth at birth, known as natal teeth.
By the time a child is six years old, a second set of 32 larger teeth, called permanent teeth, start
to erupt, or push out of the gums, eventually replacing the deciduous teeth.
Human tooth development occurs in stages. The hard tissue of the deciduous teeth, or the dentin,
forms while the fetus is in the womb. After the child is born, tooth enamel develops in stages.
Front tooth enamel, for example, is usually complete around one month after birth, while the
enamel on the second molars is not completely developed until a child is about a year and a half
old. When the enamel is fully developed the tooth erupts. Front teeth usually erupt when a child
is between 6 and 12 months of age, second molars at about 15 months old, and canines usually
erupt at 18 months. The final stage of tooth development is root completion, a slow process that
continues until the child is more than 3 years old.
Around the age of 6 years, the roots of deciduous teeth slowly resorb as the developing
permanent teeth start to push them out. Deciduous teeth eventually fall out and are replaced by
the erupting permanent teeth. This begins a transitional phase of tooth development that takes
place over the next 15 years. As baby teeth are pushed out by permanent teeth, the entire mouth
and jaw transform from their childhood shape to a more pronounced, adult-like structure. From
age 6 to age 10, a child’s permanent incisors, canines, and first molars erupt. The third molars
also called the wisdom teeth usually erupt between the age of 18 and 21 years.

Common dental health problem in community

Dental caries: (caries is Latin for "rottenness"), also known as tooth decay, cavities, or caries, is
a breakdown of teeth due to activities of bacteria. The cavities may be a number of different
colors from yellow to black.

Signs and symptoms

Pain, tooth loss, difficulty eating

The radiograph reveals an extensive region of demineralization within the dentin

Causes
Four things are required for caries formation
1. A tooth surface
2. Caries-causing bacteria
3. Fermentable carbohydrate
4. Time

CARIES-CAUSING BACTERIA: The most common bacteria associated with dental

cavities are the mutans streptococci, most prominently Streptococcus mutans and
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Streptococcus sobrinus, and lactobacilli. However, cariogenic bacteria (the ones that can
cause the disease) are present in dental plaque, but they are usually in too low
concentrations to cause problems unless there is a shift in the balance.

FERMENTABLE CARBOHYDRATES: Bacteria in a person's mouth convert glucose,

fructose, and most commonly sucrose (table sugar) into acids such as lactic acid through
a glycolytic process called fermentation.[23] If left in contact with the tooth, these acids
may cause demineralization, which is the dissolution of its mineral content. The process
is dynamic, however, as remineralization can also occur if the acid is neutralized by
saliva or mouthwash. Fluoride toothpaste or dental varnish may aid remineralization. If
demineralization continues over time, enough mineral content may be lost so that the soft
organic material left behind disintegrates, forming a cavity or hole. The impact such
sugars have on the progress of dental caries is called cariogenicity. Sucrose, although a
bound glucose and fructose unit, is in fact more cariogenic than a mixture of equal parts
of glucose and fructose. This is due to the bacteria utilising the energy in the saccharide
bond between the glucose and fructose subunits. S.mutans adheres to the biofilm on the
tooth by converting sucrose into an extremely adhesive substance called dextran
polysaccharide by the enzyme dextransucranase.

THE TOOTH SURFACE :the anatomy of teeth may affect the likelihood of caries formation.
Where the deep developmental grooves of teeth are more numerous and exaggerated, pit and
fissure caries is more likely to develop. Also, caries is more likely to develop when food is
trapped between teeth.

TIME :The frequency with which teeth are exposed to cariogenic (acidic) environments
affects the likelihood of caries development. After meals or snacks, the bacteria in the mouth
metabolize sugar, resulting in an acidic by-product that decreases pH. As time progresses, the pH
returns to normal due to the buffering capacity of saliva and the dissolved mineral content of
tooth surfaces. During every exposure to the acidic environment, portions of the inorganic
mineral content at the surface of teeth dissolve and can remain dissolved for two hours.[32] Since
teeth are vulnerable during these acidic periods, the development of dental caries relies heavily
on the frequency of acid exposure.

Management

Oral hygiene: Personal hygiene care consists of proper brushing and flossing daily. The purpose
of oral hygiene is to minimize any etiologic agents of disease in the mouth. The primary focus of
brushing and flossing is to remove and prevent the formation of plaque or dental biofilm. Plaque
consists mostly of bacteria.[95] As the amount of bacterial plaque increases, the tooth is more
vulnerable to dental caries when carbohydrates in the food are left on teeth after every meal or
snack. A toothbrush can be used to remove plaque on accessible surfaces, but not between teeth
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or inside pits and fissures on chewing surfaces. When used correctly, dental floss removes plaque
from areas that could otherwise develop proximal caries but only if the depth of sulcus has not
been compromised. Other adjunct oral hygiene aids include interdental brushes, water picks, and
mouthwashes.

Dietary modification: For dental health, frequency of sugar intake is more important than the
amount of sugar consumed. In the presence of sugar and other carbohydrates, bacteria in the
mouth produce acids that can demineralize enamel, dentin, and cementum. The more frequently
teeth are exposed to this environment, the more likely dental caries is to occur. Therefore,
minimizing snacking is recommended, since snacking creates a continuous supply of nutrition
for acid-creating bacteria in the mouth. Also, chewy and sticky foods (such as candy, cookies,
potato chips, and crackers) tend to adhere to teeth longer. However, dried fruits such as raisins
and fresh fruit such as apples and bananas disappear from the mouth quickly, and do not appear
to be a risk factor.[96] For children, the American Dental Association and the European Academy
of Paediatric Dentistry recommend limiting the frequency of consumption of drinks with sugar,
and not giving baby bottles to infants during sleep (see earlier discussion).

The use of dental sealants is a means of prevention. A sealant is a thin plastic-like coating
applied to the chewing surfaces of the molars to prevent food from being trapped inside pits and
fissures. This deprives resident plaque bacteria of carbohydrate, preventing the formation of pit
and fissure caries. Sealants are usually applied on the teeth of children, as soon as the teeth erupt
but adults are receiving them if not previously performed. Sealants can wear out and fail to
prevent access of food and plaque bacteria inside pits and fissures and need to be replaced so
they must be checked regularly by dental professionals.

Gingivitis

Gingivitis is an inflammation of the gums, usually caused by a bacterial infection. If left

untreated, it can become a more serious infection known as periodontitis.

Signs and symptoms of gingivitis

 Red or swollen gums

 Tender or bleeding gums
 Painful chewing
 Loose teeth
 Sensitive teeth
 Gums that have pulled away from your teeth

Risk factors for gingivitis

The following are risk factors for gingivitis:
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 smoking or chewing tobacco

 diabetes
 consuming certain medications (oral contraceptives, steroids, anticonvulsants, calcium
channel blockers, and chemotherapy)
 crooked teeth
 dental appliances that fit poorly
 broken fillings
 pregnancy
 genetic factors
 compromised immunity (such as HIV/AIDS patients)

Investigation

Dental examination: to assess level of inflammation probing using small ruler and determine
presence of pocket around the teeth.

X-ray to check for bone loss

History taking to exclude all likely risk factors for effective management

Treatment

Practice proper oral hygiene to treat gingivitis and also cut back on any smoking and control
your diabetes. Other treatments include deep cleaning your teeth, antibiotic medications, and
surgery.

Techniques for cleaning teeth

 Scaling removes tartar from above and below the gum line.

 Root planning: smoothes rough spots and removes infected tooth parts.
 Lasers : may remove tartar with less pain and bleeding than scaling and root planing.

Medications
A number of medications can be used to treat gingivitis.

 Antibiotic mouthwash containing chlorhexidine can be used to disinfect the mouth.

 Time-release antiseptic chips containing chlorhexidine can be inserted into pockets after
root planing.
 Antibiotic microspheres made with minocycline can be inserted in pockets after scaling
and planing.
 Oral antibiotics can be used to treat persistent areas of gum inflammation.
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Doxycycline, an antibiotic, can help keep enzymes from causing tooth damage

Surgery

 Flap surgery is a procedure where the gums are lifted back while plaque is removed. The
gums are then sutured in place to fit snugly around the tooth.
 Bone and tissue grafts can be used where the teeth and jaw are too damaged to heal.

Prevention

Gingivitis can be prevented by proper and consistent oral hygiene. Make certain to eat a balanced
diet and visit the dentist regularly. Brush your teeth twice daily with fluoride toothpaste. Floss
your teeth every day.
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Mental Health

What is Health?

Health is a quality, resulting from the total functioning of the individual in his environment that
empowers him to achieve a personally satisfying and socially useful life (Johns et al, 1975).

“a state of complete physical, mental and social well-being and not merely absence of disease or
infirmity”.(WHO, 1984)

What is Mental Health?

Mental health is the adjustment which a person makes to himself as well as to the society, so that
he/she faces realities of life and functions most effectively with the greatest satisfaction and
cheerfulness in socially acceptable ways. Or

Johns, Sutton and Webster (1962) define mental health as “the quality of personal health
resulting from the individual’s satisfaction of human needs through personal and social
adjustments in his environment”. Such an adjustment will enable the individual to:

• face his problems realistically

• make choices from several alternatives
• cope with one’s emotions maturely and skillfully
• work efficiently and live effectively
• contribute to the improvement of the society
• find satisfaction in success and happiness in carrying out one’s own role in life.

Schizophrenia is a serious brain disorder that distorts the way a person thinks, acts, expresses
emotions, perceives reality, and relates to others. Often have problems functioning in society, at
work, at school, and in relationships. It is a life-long disease that cannot be cured but can be
controlled with proper treatment.

Signs and symptom of schizophrenia

The sign and symptoms are broadly classified into three main categories

1. Positive Symptoms of Schizophrenia are refers to obvious symptoms that are exaggerated
forms of thinking or behavior that become irrational. These symptoms, which are sometimes
referred to as psychotic symptoms, include:

Delusions: Delusions are strange beliefs that are not based in reality and that the person refuses
to give up, even when presented with factual information. For example, the person suffering
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from delusions may believe that people can hear his or her thoughts, that he or she is God or the
devil, or that people are putting thoughts into his or her head or plotting against them.

Hallucinations: These involve perceiving sensations that aren't real, such as seeing things that
aren't there, hearing voices, smelling strange odors, having a "funny" taste in your mouth, and
feeling sensations on your skin even though nothing is touching your body. Hearing voices is
the most common hallucination in people with schizophrenia. The voices may comment on the
person's behavior, insult the person, or give commands.

Catatonia (a condition in which the person becomes physically fixed in a single position for a
very long time).

2. Cognitive Symptoms of Schizophrenia this may include the following:

 Poor executive functioning (the ability to understand information and to use it to make
decision
 Trouble focusing or paying attention
 Difficulty with working memory (the ability to use information immediately after learning
it)

3. Negative Symptoms of Schizophrenia this reflects the absence of certain normal behaviors in
people with schizophrenia. Negative symptoms of schizophrenia include:

 Lack of emotion or a very limited range of emotions

 Withdrawal from family, friends, and social activities
 Reduced energy
 Reduced speech
 Lack of motivation
 Loss of pleasure or interest in life

 Poor hygiene and grooming habits

Cause of schizophrenia

The exact cause of schizophrenia is not yet known. It is known, however researchers have
uncovered a number of factors that appear to play a role in the development of schizophrenia,
including:

Environmental factors: Evidence suggests that certain environmental factors, such as a viral
infection, extensive exposure to toxins like marijuana, or highly stressful situations, may trigger
schizophrenia in people who have inherited a tendency to develop the disorder. Schizophrenia more
often surfaces when the body is undergoing hormonal and physical changes, such as those that
occur during the teen and young adult years.
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Genetics (heredity): Schizophrenia can run in families, which means a greater likelihood to
develop schizophrenia may be passed on from parents to their children

Brain chemistry and circuits: People with schizophrenia may have abnormal regulation of certain
chemicals (neurotransmitters) in the brain, related to specific pathways or "circuits" of nerve cells
that affect thinking and behavior. Different brain circuits form networks for communication
throughout the brain. Scientists think that problems with how these circuits operate may result from
trouble with certain receptors on nerve cells for key neurotransmitters (like glutamate, GABA, or
dopamine), or with other cells in the nervous system (called "glia") that provide support to nerve
cells within brain circuits. The illness is not believed to be simply a deficiency or "imbalance" of
brain chemicals, as was once thought.

Management

The goal of schizophrenia treatment is to reduce the symptoms and to decrease the chances of a
relapse, or return of symptoms. Treatment for schizophrenia may include:

Medications: The primary medications used to treat schizophrenia are called antipsychotics. These
drugs do not cure schizophrenia but help relieve the most troubling symptoms, including delusions,
hallucinations, and thinking problems

First generation may include the following: chlorpromazine, haloperidol (Haldol), fluphenazine
(Prolixin), trifluoperazine (Stelazine) and etc

Second generation are as follows: aripiprazole (Abilify), quetiapine (Seroquel), risperidone

(Risperdal) etc.

Psychosocial therapy: While medication may help relieve symptoms of schizophrenia, various
psychosocial treatments can help with the behavioral, psychological, social, and occupational
problems associated with the illness. Through therapy, patients also can learn to manage their
symptoms, identify early warning signs of relapse, and develop a relapse prevention plan.
Psychosocial therapies include

 Rehabilitation, which focuses on social skills and job training to help people with
schizophrenia function in the community and live as independently as possible.
 Cognitive remediation involves learning techniques to compensate for problems
with information processing, often through drills, coaching and computer-based
exercises, to strengthen specific mental skills involving attention, memory and
planning/organization.
 Individual psychotherapy, which can help the person better understand his or her
illness, and learn coping and problem-solving skills.
 Family therapy, which can help families deal more effectively with a loved one who
has schizophrenia, enabling them to better help their loved one.
 Group therapy/support groups, which can provide continuing mutual support.
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Hospitalization: Many people with schizophrenia may be treated as outpatients. However, people
with particularly severe symptoms, or those in danger of hurting themselves or others or who cannot
take care of themselves at home may require hospitalization to stabilize their condition

 Electroconvulsive therapy (ECT): This is a procedure in which electrodes are attached to

the person's scalp and, while asleep under general anesthesia, a small electric shock is
delivered to the brain. A course of ECT treatment usually involves 2-3 treatments per week
for several weeks. Each shock treatment causes a controlled seizure, and a series of
treatments over time leads to improvement in mood and thinking. Scientists do not fully
understand exactly how ECT and the controlled seizures it causes have a therapeutic effect,
although some researcher think that ECT-induced seizures may affect the release of
neurotransmitters in the brain. ECT is less well established for treating schizophrenia than
depression or bipolar disorder, and it is therefore not used very often when mood symptoms
are absent. ECT is sometimes helpful when medications fail or if severe depression or
catatonia makes treating the illness difficult.
 Psychosurgery: In the 1940s and 1950s, a neurosurgical procedure called a prefrontal
lobotomy was sometimes used to treat severe agitation associated with psychosis. Because it
caused serious and irreversible negative effects that dulled personality and motivation, the
procedure is no longer performed as a psychiatric treatment. Other, more modern
neurosurgical procedures being studied to treat schizophrenia include deep brain stimulation
(DBS) -- an entirely different operation that is not at all related to lobotomy -- in which
stimulating electrodes are surgically implanted in brain areas believed to control thinking
and perception. DBS is an established treatment for severe Parkinson's Disease and essential
tremor, and remains experimental for the treatment of psychiatric disorders.

Depression
Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest or
Sadness of mood or loss of interest and loss of pleasure in almost all activities (pervasive sadness),
present throughout the day (persistent sadness).

Signs and symptom Common symptoms include:

o sadness
o tiredness
o trouble focusing or concentrating
o unhappiness
o anger
o irritability
o frustration
o loss of interest in pleasurable or fun activities
o sleep issues (too much or too little)
o no energy
o craving unhealthy foods
o anxiety
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Factors known to promote Depression are as follows

1. Abuse. Past physical, sexual, or emotional abuse can increase the vulnerability to clinical
depression later in life
2. Certain medication such as antiviral drug interferon-alpha, and corticosteroids.
3. Conflict. Depression in someone who has the biological vulnerability to develop depression may
result from personal conflicts or disputes with family members or friends.
4. Genetics. A family history of depression may increase the risk. It's thought that depression is a
complex trait, meaning that there are probably many different genes that each exert small effects,
rather than a single gene that contributes to disease risk.
5. Major events. Even good events such as starting a new job, graduating, or getting married can
lead to depression. So can moving, losing a job or income, getting divorced, or retiring. However,
the syndrome of clinical depression is never just a "normal" response to stressful life events.
Some the clinical features of Depression
Depressive cognitions: Hopelessness (a feeling of ‘no hope in future’ due to pessimism),
helplessness (the patient feels that no help is possible), worthlessness (a feeling of
inadequacy and inferiority), unreasonable guilt and self-blame over trivial matters in the
past.
Suicidal thoughts: Ideas of hopelessness are often accompanied by the thought that life
is no longer worth living and that death had come as a welcome release. These gloomy
preoccupations may progress to thoughts of and plans for suicide.
Psychomotor activity: Psychomotor retardation is frequent. The retarded patient thinks,
walks and acts slowly. Slowing of thought is reflected in the patient’s speech; questions
are often answered after a long delay and in a monotonous voice. In older patients
agitation is common with marked anxiety, restlessness and feelings of uneasiness.
Psychotic features: Some patients have delusions and hallucinations (the disorder may then be
termed as psychotic depression); these are often mood congruent i.e. they are related to
depressive themes and reflect the patient’s dysphoric mood. For example, nihilistic delusions
(beliefs about the non-existence of some person or thing), delusions of guilt, delusions of
poverty etc may be present.

Management

Cognitive therapy: It aims at correcting the depressive negative cognitions like

hopelessness, worthlessness, helplessness and pessimistic ideas and replacing them with
new cognitive and behavioural responses.
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• Supportive psychotherapy: Various techniques are employed to support the patient.

They are reassurance, ventilation, occupational therapy, relaxation and other activity
therapies.

Group therapy: Group therapy is useful for mild cases of depression. In group therapy
negative feelings such as anxiety anger, guilt, despair are recognized and emotional
growth is improved through expression of their feelings.
• Family therapy: Family therapy is used to decrease intrafamilial and interpersonal
difficulties and to reduce or modify stressors, which may help in faster and more
complete recovery.
• Behaviour therapy: It includes social skills training, problem solving techniques,
assertiveness training, self-control therapy, activity scheduling and decision making
techniques.

Medical management may include the following drug

Selective serotonin reuptake inhibitors (SSRIs): These medications are safer and generally
cause fewer side effects than other types of antidepressants. SSRIs include fluoxetine (Prozac),
paroxetine (Paxil, Pexeva),

Serotonin-norepinephrine reuptake inhibitors (SNRIs): Examples of SNRIs include duloxetine

(Cymbalta), venlafaxine
Tricyclic antidepressants: These antidepressants such as imipramine (Tofranil), nortriptyline
(Pamelor), amitriptyline, doxepin, trimipramine.
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Glaucoma : This is a group of condition in which there is increased intraocular pressure due to
impaired drainage fluid through scleral venous sinus (canal of Schlemm) in angle between the
iris and cornea in the anterior chamber. Persistently raised intraocular pressue may damage the
optic nerve by mechanical compression and compression of its blood supply causing ischaemia.

Cause of Glaucoma
Secondary glaucoma occurs due to a known cause. Both open- and closed-angle glaucoma can
be secondary when caused by something known. Causes include:
o Drugs such as corticosteroids
o Eye diseases such as uveitis (an infection of the middle layer of the eye)
o Diseases such as diabetes
o Eye injury

Types of Glaucoma

1. Primary Open-Angle Glaucoma

In open-angle glaucoma, the angle in your eye where the iris meets the cornea is as wide and
open as it should be, but the eye’s drainage canals become clogged over time, causing an
increase in internal eye pressure and subsequent damage to the optic nerve. It is the most
common type of glaucoma, affecting about four million Americans, many of whom do not know
they have the disease .The inner eye pressure (also called intraocular pressure or IOP) rises
because the correct amount of fluid can’t drain out of the eye. With open-angle glaucoma, the
entrances to the drainage canals are clear and should be working correctly. The clogging problem
occurs further inside the drainage canals, similar to a clogged pipe below the drain in a sink.
Most people have no symptoms and no early warning signs. If open-angle glaucoma is not
diagnosed and treated, it can cause a gradual loss of vision due to atrophy of optic disc. This type
of glaucoma develops slowly and sometimes without noticeable sight loss for many years. It
usually responds well to medication, especially if caught early and treated.

2. Angle-Closure Glaucoma

Angle-closure glaucoma, a less common form of glaucoma Is caused by blocked drainage canals,
resulting in a sudden rise in intraocular pressure, has a closed or narrow angle between the iris
and cornea, develops very quickly, has symptoms and damage that are usually very noticeable
and demands immediate medical attention.

Sign and Symptom

Photophobia

Sudden severe pain

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Loss of vision accompany by attack

3. Normal-Tension Glaucoma

Normal Tension Glaucoma also called low-tension or normal-pressure glaucoma, In normal

tension glaucoma the optic nerve is damaged even though the pressure in the eye is not very
high. However In general, a normal pressure range is between 12-22 mm Hg.

4. Congenital Glaucoma or Childhood glaucoma

This type of glaucoma occurs in babies when there is incorrect or incomplete development of the
eye's drainage canals during the prenatal period especially anterior chamber. This is a rare
condition that may be inherited or maternal infection such as rebella in early pregnancy. When
uncomplicated, microsurgery can often correct the structural defects .It is usually diagnosed
within the first five year of life.

Sign and symptom

 Enlarged eyes

 Cloudiness of the cornea

 Photosensitivity

 Excessive tearing

Clinical Investigation

 Tonometry
 Ophthalmoscopy
 Perimetr
 Gonioscopy

Medication use for management of glaucoma

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 Prostaglandins. These increase the outflow of the fluid in your eye (aqueous humor) and
reduce pressure in your eye and could be use when Beta blocker is contraindicated. However
the drug could be used in conjunction with other antiglaucoma drug(Carbonic anhydrase
inhibitor) Examples include latanoprost .Possible side effects include mild reddening and
stinging of the eyes, darkening of the iris, changes in the pigment of the eyelashes or eyelid
skin, and blurred vision.
 Beta blockers. These reduce the production of fluid in your eye, thereby lowering the
pressure in your eye (intraocular pressure). Examples include timolol (Betimol, Timoptic)
and betaxolol (Betoptic). Possible side effects include difficulty breathing, slowed heart rate,
lower blood pressure, impotence and fatigue.
 Alpha-adrenergic agonists. These reduce the production of aqueous humor and increase
outflow of the fluid in your eye. Examples include apraclonidine (Iopidine) and brimonidine
(Alphagan). Possible side effects include an irregular heart rate; high blood pressure; fatigue;
red, itchy or swollen eyes; and dry mouth.
 Carbonic anhydrase inhibitors. Rarely used for glaucoma, these drugs may reduce the
production of aqueous humor in eye. Examples include Acetazolamide 250mg to 500mg.
Possible side effects include a Nausea, Vomiting, loss of appetite, fatigue, irritability,
electrolyte imbalance.
 Miotic or cholinergic agents. These increase the outflow of fluid from your eye. An
example is pilocarpine (Isopto Carpine). Side effects include smaller pupils, possible blurred
or dim vision, and nearsightedness.

Surgery

 Laser therapy
 Filtering surgery
 Drainage tubes
 Electrocautery

Laser therapy: Laser trabeculoplasty is an option for people with open-angle glaucoma a
beam to open clogged channels in the trabecular meshwork. It may take a few weeks before the
full effect of this procedure becomes apparent.

Filtering surgery: With a surgical procedure called a trabeculectomy, an opening is create in

the white of the eye (sclera) and removes part of the trabecular meshwork.

Drainage tubes: In this procedure, your eye surgeon inserts a small tube in your eye.
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Electrocautery: a minimally invasive procedure to remove tissue from the trabecular meshwork
using a small electrocautery device called a Trabecutome.

Possible complications may arise from the surgery include:

Infection,

Bleeding

Abnormally low eye pressure

Loss of vision

Some types of eye surgery may speed the development of cataracts.

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