WAHID HERU WIDODO

DEPARTMENT OF OPHTHALMOLOGY
MARGONO SOEKARJO GENERAL HOSPITAL
DEFINITIONS
 A group of diseases that have in common optic
neuropathy with associated visual field loss
which elevated intraocular pressure (IOP)
is one of the primary risk factors
PHYSIOLOGY OF AQUEOUS HUMOR
3 FACTOR DETERMINE IOP :
 The rate of aqueous humor production by the ciliary
body
 Resistance to aqueous outflow across the trabecular
meshwork-Schlemm’s canal system
 The level of episcleral venous pressure
FORMATION & FLOW OF AQUEOUS
 Produced by the ciliary body
 Flow of aqueous : COP  pupil  COA
trab meshwork  Schlemm’s canal 
collector channels venous system
PATHOPHYSIOLOGY OF GLAUCOMA
 Mechanical theory
 Ischemic theory
 Disturbance autoregulation
CLINICAL ASSESMENT IN GLAUCOMA
 TONOMETRY
 GONIOSCOPY
 OPTIC DISK ASSESMENT
 VISUAL FIELD EXAMINATION
 TONOMETRY
 Schiotz tonometry

 Digital tonometry
 GONIOSCOPY
 OPTIC DISK ASSESMENT (Funduscopy)
NORMAL

GLAUCOMATOUS
 VISUAL FIELD EXAMINATION
 Confrontation test

 Goldman Perymetry
TREATMENT OF RAISED IOP
 MEDICAL TREATMENT
- Suppression of aqueous production
 Beta adrenergic blocking agent ( timolol 0,25% & 0,5%, betaxolol
0,25% & 0,5% )
 Carbonic anhydrase inhibitors ( acetazolamide )

- Facilitation of aqueous outflow

 Parasympathomimetic agent ( pilocarpine 2% )
 Epinephrine 0,25%
 Prostaglandine analogs ( latanoprost 0,005% )
 REDUCTION 0F VITREOUS VOLUME
 Hyperosmotic agent
oral glycerin 1 ml/kg body weight, intravenous mannitol
 SURGICAL AND LASER TREATMENT
 Peripheral iridotomy, iridectomy, and iridoplasty
 Laser trabeculoplasty
 Glaucoma drainage surgery ( trabeculectomy,
sclerectomy, goniotomy )
Peripheral iridotomy
Laser trabeculoplasty
Trabeculectomy
 CYCLODESTRUCTIVE PROCEDURES
 Cryotherapy
 Diathermy
GLAUCOMA CLASSIFIED ACCORDING TO
ETIOLOGY
 Primary glaucoma
1. open angle glaucoma
2. angle closure glaucoma
 Congenital glaucoma
 Secondary glaucoma
 Absolute glaucoma
GLAUCOMA CLASSIFIED ACCORDING TO MECHANISM OF IOP
RISE
 OPEN ANGLE GLAUCOMA
1. Pretrabecular abnormalities
2. Trabecular abnormalities
3. Posttrabecular abnormalities
 ANGLE CLOSURE GLAUCOMA
1. Pupillary block
2. Anterior lens displacement
3. Angle crowding
4. Peripheral anterior synechiae
PRIMARY OPEN ANGLE
GLAUCOMA
 The chief pathologic feature  degenerative process in trabec meshwork
 Diagnosis :
. Glaucomatous optic disk
. Visual field 
. IOP 
 Therapy :
. Medical tx
. Surgical tx ( trabeculectomy )
PRIMARY ANGLE CLOSURE GLAUCOMA
 Elevation of IOP caused by occlusion of trab meshwork by the peripheral
iris

ACUTE ANGLE CLOSURE GLAUCOMA

Clinical findings :
 Sudden onset of visual loss
 Pain
 Halos
 Nausea and vomiting
Treatment :
 Iridotomy ( Laser or surgical )
 Medical tx
CONGENITAL
GLAUCOMA
 Primary congenital glaucoma
 The anterior segment developmental anomalies ( Axenfeld-
Rieger synd, etc )
 A variety of other conditions ( Aniridia )
CLINICAL FINDINGS
 Epiphora
 Photophobia
 Increased corneal diameter
 Increased IOP
 Buphthalmos
THERAPY
 Surgical ( goniotomy, trabeculectomy )
THANK YOU