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Glaucoma
-Indentation tonometry:
Schiotz tonometry .
-Applanation tonometry:
Goldmann tonometry
• Eye ball can be considered as a closed
system with relatively constant contents,
except the aqueous humor.
• while wide
separation between
the two indicate open
angle .
Gonioscopy:
Examination of the
angle of the anterior
chamber performed by
goniolenses
Optic disc:
• Anterior end of the optic nerve, about 1.5
mm in diameter. Lies about 3mm from the
fovea. All retinal layers except the nerve
fiber layer stop at the margin of the optic
disc. The nerve fiber layer pass through the
lamina cribrosa a sieve like structure, bridge
the posterior scleral foramen.
• Congenital glaucoma
Buphthalmus
• Primary glaucomas are not associated with ocular or systemic
inherited.
aqueous outflow.
Interference with
axoplasmic flow
Risk factors
• 1- Age
• 2- Race: more common and a more
severe in Blacks .
• 3- Family history and inheritance.
• 4- Myopia: increased incidence of POAG.
• 5- D.M and vascular disease .
Diagnosis
History
1) Visual symptom will usually be absent , unless damage is advanced .
2) Previous ophthalmic history (Refractive status and causes of secondary
glaucoma )
3) F.H
4) PMH
5) Current medication and allergies .
Examination
1) V.A
2) Pupil
3) SLE
4) Tonometry noting the time of the day
5) Gonioscopy
6) Optic disc examination
7) Perimetry
8) Optic disc or peripapillary RNFL imaging .
IOP > 21mmHg is
suspicious .
Optic nerve head damage : Increase
in cup/disc ratio.
Medical:
Mode of action: decrease the aqueous production e.g. Timolol 0.5% eye
drops
C- Cholinergic drug
Mode of action: increase the aqueous outflow e.g. Pilocarpine 2% eye drops
D- Sympathomimetics drugs;
E- Prostaglandin derivatives
asymmetrical
Classification
• 1. Latent
• 2. Subacute
• 3. Acute
• 4. Chronic
• 5. Absolute
Subacute ( Intermittent) Angle
Closure Glaucoma
Sudden onset of
1-Blurring of vision
The attack may last for 1-2 hours and usually broken by
miosis (constriction of the pupil) e.g. exposure to bright light.
Signs
o Corneal edema
o Elevated IOP
• 1- Lens-related glaucoma
• 2- Neovascular glaucoma
• 3- Inflammatory glaucoma
• 4- Intra ocular tumor may push iris lens
diaphragm forward and closing the angle
1-Lens-related glaucoma:
• a- Phacolytic glaucoma.
Causes
1. Central retinal vein occlusion. (commonest cause)
2. Diabetes mellitus (proliferative diabetic retinopathy).
3. Miscellaneous
Carotid obstructive disease.
Central retinal artery occlusion.
Intraocular tumours.
Long standing retinal detachment.
Chronic intraocular inflammation.
Inflammatory glaucoma
Congenital Glaucoma
• Affect 1:10,000 births
o True congenital glaucoma: represents (40%) of all
congenital glaucoma
o 2- Infantile glaucoma: represents (55%) of congenital
glaucomas,
o Juvenile glaucoma: represents (5%) of congenital
glaucomas,
• 75% bilateral
• 65% male
Clinical features
• Corneal haze.
• Buphthalmos.
• Breaks in descement
membrane. (Haab striae)
• Optic cupping
Diagnosis
• Corneal diameter
• IOP
• C/D ratio
Treatment
• Surgical
Goinotomy .
Trabeculectomy .