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GLAUCOM

A
Dr. NENI K. PARIMO, Sp.M

GLAUCOMA
 Definition
A damage of optic nerve head (Papil N.Opticus)
characterized by:
- Excavation of optic nerve papil
- Narrowing of visual field
Primarily caused by increase of intra ocular pressure

 Intra Ocular Pressure (IOP)
High IOP  > 22 mmHg

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Non-contact • Digital .Contact .Technique  pressing the eyeball with two pointing .Estimation .Comparing right and left eye .IOP examination: Digital Schiotz indentation tonometer Applanation tonometer .

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• Schiotz Tonometer  points on scale  conversion to mmHg • Applanation Tonometer •  indicates mmHg .

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the weight is added (replaced) by 7.IOP Examination with Schiotz tonometer: Give inform consient to the patient Patient lies in bed Apply topical Pantocaine 0.5g or 10g .5% on eye Tonometry with 5.5g weight is tested on the steel plate  points at zero Tonometry is put over cornea Read the scale  convert by provided table to mmHg If the reading is < 3.

Excavation > 0.Normal C/D Ratio 0.2 – 0. Optic Nerve Papil .3 .6 .

Humphrey .Visual Field Examination : • Confrontation Test • Tangent Screen • Goldman Perimetry • Computerized  .Octopus .

Open angle / simple chronic glaucoma 2. Chronic closed angle glaucoma / chronic congestive glaucoma 3.Glaucoma Classification A. Acute closed angle glaucoma / acute congestive glaucoma According to gonioscopy . Primary Glaucoma 1.

. Corticosteroid 6. Absolute Glaucoma  No vision / LP – 2. Congenital Glaucoma D. Lens Dislocation Cataract 3. Rubeosis iridis C. Uveitis 4. Secondary Glaucoma 1. Hyphema 5.B.

A. Primary Glaucoma Dynamics of Humor Aqueous : Production  cilliary body nonepithelium Posterior chamber  pupil  anterior chamber Conventional  Trabeculair Meshwork  Schlemm’s canal ( + 80 – 85% ) Non conventional  Uvea-sclera ( 15 – 20% ) .

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visual field narrowing .open angle .enlargement of C/D Ratio .frequent bumping on movement / walking .Open angle glaucoma/ chronic simple glaucoma .progressive .bilateral Symptoms : .IOP > 22 mmHg .tunnel vision Signs : .white eye with blurred vision .chronic .

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Restriction of the Visual Field .

Pathophysiology . Schlemm’s canal .Degeneration of trabecula.Genetic aspect .

50% eyedrops 2 x1 /day -.Treatment A.25% 0.25% .Pilocarpin 1.Selective Receptor β1 Betaxolol 0.Prostaglandin Analogue : Latanoprost. Travaprost  1x 1 drop at evening .4%  4 – 6 x/day -.0.50% 2 x/day -.Asetazolamide tablets /Carbonic anhydrase inhibitor 125 – 250 mg  4 x 250 mg/ day -- Beta Adrenergic Blocking Agent  Timolol 0. Medication -.

If medication fails C.If medication and Laser trabeculoplasty fails .Most common  Trabeculektomy .B. Laser Trabeculoplasty . Surgery .

Pathway of aqueus egress following trabeculectomy .

Ocular hypertension  High IOP  > 22mmHg  No sign of glaucomatous optic nerve damage ..Low Tension Glaucoma Intra ocular pressure  within normal limits Signs of glaucoma present  Damage of the optic nerve  excavation  Visual field defect .

Pupillary block .Acute Primary Angle Closure Glaucoma ( Acute PACG) Pathophysiology .No pupillary block / cilliary block  Most common: pupillary block .

Predisposing factors: .Shallow anterior chamber .Short eye / axial length .Pupillary block 1.Age 2.Small corneal diameter .Narrow angle .Swollen lens - .Mid mydriasis . Triggering factors .

Symptoms : .Halo / seeing rainbows  blurred vision Signs: - IOP > 22 mmHg PCI + CI Corneal edema  bullous keratopathy Shallow anterior chamber Flare Atrophy of the iris Mid Mydriasis Glaucomflecken (cataract due to IOP ) . nausea.Eye pain .Dizziness. vomiting .

PAINFUL RED EYE WITH VISUAL LOSS REFER IMMEDIATELY .

Iridectomy / laser iridotomy .Fellow eye  preventive iridectomy / laser iridotomy .Medical therapy for preparation of definitive treatment .Definitive treatment : .Definitive treatment: < 48 – 72 jam  iridectomy / laser iridotomy > 48 – 72 jam  trabeculectomy .Trabeculektomy Management: .

1ml/KgBW in 50% solution (mixed with water) .Glyserin p.Timolol 0.v 1 – 2 g/KgBW  Preparation for surgery if IOP is not reduced .Mannitol i. initial dose 500mg  4 x 250 mg .Pilocarpin 2%  4 – 6 x 1 drop .o.5%  2 x 1 drop .Medical Therapy : .Acetazolamide.Treat pain  analgesics .

Intermittent pupillary block .No pupillary block / cilliary block intermittently  Most common by pupillary block .Chronic Closed angle Glaucoma (Chronic PACG) Pathophysiology .

Signs & Symptoms Same as Acute PACG but less severe Treatment Same as Acute PACG .

Phacolytic . Secondary Glaucoma 1.B. Phacomorphic .intumescent  cataract pupillary block  closed angle glaucoma 2. Lens Dislocation 2.Hyper mature cataract  . Cataract  there are 2 pathogenesis : 1.

3. Hyphema blood particle trabecular meshwork obstruction open angle glaucoma  4. Uveitis  there are 2 pathogenesis : 1. Pupillary seclusion  iris bombe  PAS  closed angle glaucoma 2. Infllamatory cells inflamasi  trabecular meshwork obstruction  open angle glaucoma .

Rubeosis iridis anterior Formation of fibrovascular tissue at chamber angle .Trabecular meshwork damage 6. Corticosteroid use .5.

C. Congenital Glaucoma Symptoms : Light irritability Cranky Tearing Eyeball enlargement Signs : High IOP Epiphora Blepharospasm Photophobia Buftalmos .

OD Bulpthalmos. OS Bulpthalmos .

Treatment: Goneotomy surgery Trabeculotomy surgery Trabeculectomy surgery .

D. where the vision is zero / Light Perception ( . Absolute Glaucoma Is the end stage of all kinds of glaucoma.) .

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