Primary Open Angle Glucoma

A Case Presentation
Dr.Debalina Ghanta
PGT
Dept.Of Ophthalmology
NRS Medical College & hospital
 Particulars of Patient
• Name:Surajit Chandra
• Age:56yrs
• Sex:Male
• Religion:Hinduism
• Occupation:office worker
• Address:Bishorpara,North Dumdum,N 24
Parganas
 Chief Complaints
• Gradual painless dimness of vision in BE for
last 3 years
 History of Present Illness
• Dimness of vision in BE ,which is insidious
onset,gradual ,painless progressive in nature.
• Associated with intermittent watering from
same eye and headche.Headche is not
associated with nausea &/vomitting.
• Frequent change of glasses within 3 years
• Patient opted for self -medications but the
symptoms did not resolve
• There is no history of
trauma to the eye
Nausea
Vomitting
Sudden transient visual loss
metamorphopsia
Coloured haloes
floaters
 History of Past ocular illness
• No significant past surgical history
• No significant past ocular disease of similar
complaint.
• No significant past history of recurrent
uveitis,recurrent red eye or allergic disorder.
 Medical History
• Diagnosed as Hypertensive,on Rx for 5 years
• No history of
DM
Bronchial Asthma
Migraine
Hyperlipidemia
Cardiovascular disease
Thyroid disorder
CVA/hemodynamic crisis
Renal disease
 Drug History
• Under Anti-HTNsive
medications(tab.Telmisartan 40) for 5 years.
• No history of steroid use in any
formulations,no history of Topiramate,TCA use
• No other significant drug history
• No significant systemic,ocular or drug allergy
 Personal & family History
• Addiction of Cigerette Smoking for 6 years
• No family history of glaucoma
• Lower-middle socio-economic background
 General Examination
• C/A/C
• P0/E0/C0/I0
• BP:168/86mm Hg
• PR:88bpm
• RR:18bpm
• Temp.:980 F
 Ocular Examination
Visual Acuity R/E L/E
Unaided
Distant vision 6/60 6/60
Aided
Distant vision 6/18 6/24
Near Vision N/12 N/12
 Ocular examination
R/E L/E
Colour vision WNL WNL
Pupillary reflex Brisk Brisk
Ocular motility Full in all gazes Full in all gazes
eyeball orthophoria orthophoria
 Slit Lamp Examination
R/E L/E
Eyelid and adnexa Normal Normal
Conjunctiva Normal Normal
Cornea Clear Clear, NoKPs/No pigments
No KPs/No pigments on on endothelium
endothelium
Ant.chamber AC depth:Van Herick grade Van Herick grade 4
4 No cells/flare
No cells/flare
Iris Normal Normal
No No
iridodonesis/iridodialysis iridodonesis/iridodialysis
No heterochromia No heterochromia
No ectropion uvuae No ectropion uvuae
No NVI seen No NVI seen
No transillumination No transillumination
defect defect
 Slit lamp examination,contd.
Pupil Round,Reacting to light,No Round,Reacting to light,No
RAPD at present RAPD at present
No exfoliation material No exfoliation material
/pigments present at /pigments present at
pupillary border pupillary border
No posterior synechiae No posterior synechiae
present present
Pupillary ruff -N Pupillary ruff -N
 R/E L/E
Lens NS1 cataract NS1 cataract
No Pigmentary/exfoliative No Pigmentary/exfoliative
material deposition material deposition
No phacodonesis No phacodonesis

Gonioscop Wide open in all angles Wide open in all angles

y SS SS
SS SS SS SS
SS SS
Pigments 2+in all Pigments 2+in all
quadrants quadrants
Iris insertion :flat Iris insertion :flat
No angle recession,dusty No angle recession,dusty
pigmentation of pigmentation of
angle,PAS,neovascularisa angle,PAS,neovascularisa
tion seen tion seen
No pigmentation on No pigmentation on
Schwalbe’s line Schwalbe’s line
No surgical /laser osteum No surgical /laser osteum
seen seen
Cont.
Fundus examination

Fundus
Optic Disc Vertically oval disc with Vertically oval disc with VCDR
VCDR 0.6:1 0.7:1
No disc haemorrhage at No disc Haemorrhage at
present present
Disc Colour Pallor+ Pallor++
NRR Superior rim notching Superior and inferior rim
notching
Blood vessels Nasal Shifting Nasal Shifting
NFLD present present
Peripapillary ɑ/ɓzone Present present

Macula FR + FR +
Fundus pic.
 Intra ocular pressure

• Goldmann Applanation Tonometer-at 10.00

a.m. RE-24mm Hg
LE-26 mm Hg
 Ocular investigations
• CCT:=RE-533 mcm
LE-513 mcm
• Visual Field Analysis(HFA 24-2)
-showed BE superior and inferior arcuate
scotoma.
 Suggested Investigations
Systemic:
CBC with ESR
• FBS&PPBS
• Lipid Profile
• Thyroid function test
• Ocular :
• OCT of RNFL and ONH analysis
 Provisional Diagnosis

A case of newly diagnosed BE Primary open angle glaucoma

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