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NIMATUL MUTHMAINNAH
I11111054
Definition
Glaucoma is a disorder in which increased
intraocular pressure damages the optic nerve.
Primary glaucoma refers to glaucoma that is
not caused by other ocular disorders.
Secondary glaucoma may occur as the result
of another ocular disorder or an undesired side
effect of medication or other therapy.
Classification
According to the spesific pathofisiology
Risk factor
Age
Intraocular pressure
Race/ ethnicity
Family history of glaucoma
Pseudoexfoliation
Myopia
Symtomps
Unspesific symptoms
Headache
Burning sensation in the eyes
Blurred or decreased vision
Symtomps
Acute onset of intense pain. The elevated
intraocular pressure acts on the corneal nerves
to cause dull pain.
Nausea and vomiting
visual acuity
Prodromal symptoms--blurred vision or the
appearance of colored halos around lights
Juvenile glaucoma
Any abnormal increase in intraocular pressure
during the first years of life will cause dilatation
of the wall of the globe, and especially of the
cornea.
The result is a characteristic, abnormally large
eye (buphthalmos) with a progressive increase in
corneal diameter.
Symptoms
Photophobia
Epiphora
corneal opacification,
Unilateral or bilateral enlargement of the cornea.
These changes may be present from birth (in
congenital glaucoma) or may develop shortly
after birth or during the first few years of life.
Children with this disorder are irritable, poor
eaters, and rub their eyes often.
Sign
Pathogenesis
The major mechanism of visual loss in glaucoma
is retinal ganglion cell apoptosis, leading to
thinning of the inner nuclear and nerve fiber
layers of the retina and axonal loss in the optic
nerve. The optic disk becomes atrophic, with
enlargement of the optic cup
Pathogenesis
Increase of TIO induced mechanic damage in
akson optic nerve
Increase of TIO also induced ischemic of nerve
akson due to decreased blood flow in papil optic
nerve.
Examination
Oblique illumination of the anterior chamber--The anterior chamber is illuminated by a beam of light
tangential. a shallow anterior chamber an angle that is
partially or completely closed
Slit lamp examination-- Gonioscopy
Measuring intraocular pressure--- Palpation,
Schitz,
Optic disk ophtalmoscopy --- increase in the size of
the optic cup and to pale discoloration of the optic disk
Visual field testing
Diferential Diagnosis
Acute Iritis
Acute Konjuctivitis
Treatment
Pilokarpin 2% a drop/min in 5 min, after that
every 1 hour
Asetazolamid 500mg IV (TIO > 50mmHg) or
oral (TIO < 50mmHg)
alternative : mannitol 20% 1-2g/KgBB, gliserol
50% 1-1,5g/kgBB (KI: DM).
Surgical Indications
Medical therapy is insufficient.
The patient does not tolerate medical therapy.
The patient is not a suitable candidate for
medical therapy due to lack of compliance in
applying eyedrops.
Trabeculoplasty
Laser burns in the trabecular meshwork cause
tissue contraction that widens the intervening
spaces and improves outflowthrough the
trabecular meshwork.
Laser surgery in the angle of anterior chamber is
possible only if the angle is open.
Peripheral iridectomy
A limbal incision is made at 12 oclock under
topical anesthesia or general anesthesia,
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