Glaucoma Diska

8/13/2019 Glaucoma Diska

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GLAUCOMA

Diska Astarini

I11109083


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Glaucoma is an optic neuropathy characterized by

cupping of the optic disc and the loss of visual

field.

Associated to intraocular pressure (IOP) visual field sensitivity and eventually leads to

blindness in the affected eye


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Worldwide, glaucoma is the leading cause of

irreversible blindness

Almost 60 millions people have Glaucoma.In fact, as many as 6 millions individuals are

blind in both eyes from this disease


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Pathophysiologyincreased intraocular pressure(usually > 24 mmHg)

Overproduction of HA with normal

Drainage

block of fluid flow from posterior to

anterior chamber

reduced flow through the trabecular

meshwork

Ischemic of Optical

nerve

Push Optical Nerve

Diffuse ganglional cell

atrophy

Effect to the Vision
http://en.wikipedia.org/wiki/Ocular_hypertensionhttp://en.wikipedia.org/wiki/Ocular_hypertension


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Risk Factors

Age

Family History

Drug consumption (steroid)

Trauma

Severe Hypermethrophya

Other systemic disease (ex ; DM, Hypertension)


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Sign and symptom

Symptoms may include:

Blurred vision

Severe eye pain

Headache

Rainbow haloes around lights

Nausea and vomiting

Elevated intraocular pressure

Visual field loss

Optic disk changes

Enlargement of the eye.


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Diagnosis

Measuring intra ocular pressure (tonometry);

Inspecting the drainage angle of your eye (gonioscopy);

Evaluating any optic nerve damage (ophthalmoscopy);

Testing the visual field of each eye (perimetry).


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Classification

1. Open Angle Glaucoma

2. Angle closure glaucoma

3. Congenital Glaucoma

4. Secondary glaucoma

Glaucoma can be divided roughly into two maincategories, "open angle" and "closed angleglaucoma.


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Types of glaukcoma

Types Cause Symptoms Comment

Chronic Open Angle

Glaucoma

Gradual blockage of

drainage channel

Pressure builds slowly

Gradual loss of side

vision

Affects side vision first

This type of glaucoma

progresses very slowly

andis a lifelong condition.

Acute Closed

Angle Glaucoma

Total blockage of

drainage channel

Sudden increase

in pressureNausea

Blurred vision

Severe pain

Halos around lights

This condition

constitutes a

medical emergency, as

permanent blindnessoccurs rapidly without

immediate treatment.

Secondary Glaucoma Injury, infection, tumors,

drugs, or inflammation

cause scar tissue which

blocks the drainage

channel

Gradual loss of side

vision

Affects side vision first

This form of glaucoma

may progress slowly, as

in cases of chronic

glaucoma.

Congenital

Glaucoma

Fluid drainage system

abnormal at birth

Enlarged eyes

Cloudy cornea

Light sensitivity

Excessive tearing

This condition must be

treated soon after birth if

vision is to be saved.

A aGrafix materials call 770-641-7310 - Atlanta GA USA


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Examination Methods


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Oblique Illumination of the Anterior Chamber


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Slit-Lamp Examination


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Gonioscopy Gonioscopy can differentiate the following conditions:

Open angle: open angle glaucoma.

Occluded angle: angle closure glaucoma.

Angle access is narrowed: configuration with imminent risk

angle of an acute closure glaucoma.

Angle is occluded: secondary angle closure glaucoma, for

example due to neovascularization in rubeosis iridis.

Angle open but with inflammatory cellular deposits,

erythrocytes, or pigment in the trabecular meshwork: secondary

open angle glaucoma.


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Measuring Intraocular Pressure


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Applanation Tonometry


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Visual Field Testing

visual field testing can be grouped into several

important categories:

Confrontational

Amsler grid

Static perimetry

Kinetic perimetry Frequency doubling analysis


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Treatment

Principe: reducing IOP by decreasing aqueous

production or increasing aqueous outflow

Currently, the effectiveness of a medication in

the treatment of glaucoma is measured by its

ability to lower IOP

Medical, surgical or laser


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Medical Treatment Suppression of Aqueous Production

Topical beta-adrenergic blocking agents, Apraclonidine,Brimonidine, Dorzolamide hydrochloride and brinzolamide,Carbonic anhydrase inhibitorsacetazolamide

Facilitation of Aqueous OutflowThe prostaglandin analogsbimatoprost 0.003%, latanoprost0.005%, and travoprost 0.004% solutions,Parasympathomimetic agents Pilocarpine, Epinephrine,Dipivefrin

Reduction of Vitreous VolumeHyperosmotic agents, Oral glycerin (glycerol)

Miotics, Mydriatics, and Cycloplegics


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Surgical and laser treatment

Peripheral Iridotomy, Iridectomy, andIridoplasty

Laser Trabeculoplasty

Glaucoma Drainage Surgery Trabeculectomy

Viscocanalostomy and deep sclerectomy with

collagen implant Goniotomy

Cyclodestructive Procedures


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OPEN ANGLE GLAUKOMA


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OPEN ANGLE GLAUCOMA

Primary open-angle glaucoma (POAG), the mostcommon form of glaucoma, accounts for 6070% of all glaucomas and 9095% of primaryglaucomas.

POAG is a bilateral,chronic progressive conditionthat typically appears in

individuals over 60years of age

PRIMARY OPEN ANGLE GLAUCOMA


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Groups at risk

Age : from the 40-49 age group into those

aged over 80.

ocular hypertension

myopia


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Signs

the optic disc changes.

The cup to disc ratio

increases. Asymmetry

of disc cupping


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Diagnostic considerations

Measurement of intraocular pressure

Elevated intraocular pressure is an alarming

sign

Twenty-four-hour pressure curve

Fluctuations in intraocular pressure of over 5

6 mmHgmay occurover a 24-hour period.

Gonioscopy

Ophthalmoscopy


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treatment

The goal is to maintain IOP less than 21 mmHg

and continued visual field loss should be minimal.

Various treatment modalities include medical

treatment, laser therapy,and surgery.

Patients will initially start with topical ocular drug

therapy

Prognosis : If discovered early and treatedadequately, the prognosis for POAG is excellent


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ACUTE ANGLE CLOSURE

GLAUCOMA


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Acute angle closure glaucoma

History

The attack comes on quite quickly

the intraocular pressure rises rapidly

Red eye

There is pain in one eye, can be extremely severe

impaired vision and haloes around lights

may have had similar attacks in the past may be systemically unwell, with severe

headache, nausea, and vomiting


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Risk factors

increasing age

female gender

family history of glaucoma

South-East Asian, Chinese, or Inuit ethnic

background.


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Examination

The eye is inflamed and tender

The cornea is hazy and the pupil is semidilated

and fixed. Vision is impaired according to the

state of the cornea

On gentle palpation the eye feels harder than

the other eye.

The anterior chamber seems shallower than

usual, with the iris being close to the cornea


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Aqueous Humor flow after iridectomy


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Congenital Glaucoma

Primary congenital glaucoma

Together with other anomaly


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Primary Congenital Glaucoma

Present at birth; however, but its manifestationsmay not be recognized until infancy or earlychildhood

Pathophysiology : Primary congenital glaucoma isrestricted to a developmental abnormality thataffects the trabecular meshwork

Estimated to affect fewer than 0.05% of

ophthalmic patients The disease is bilateral in approximately 75% of

cases.


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Primary congenital glaucoma usually is diagnosed

at birth or shortly thereafter, and most cases are

diagnosed in the first year of life.

Most cases oare sporadic in occurrence may betransmitted through an autosomal recessive

pattern

Male patients are found to have a higherincidence of the disease, comprising

approximately 65% of cases.


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Clinical

History

Triad of manifestations :

Epiphora

Photophobia

Blepharospasm


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Secondary glaucoma Inflammatory glaucoma

Uveitis of all types

Fuchs heterochromic iridocyclitis

Phacogenic glaucoma

Angle-closure glaucoma with mature

cataract

Phacoanaphylactic glaucoma secondary to

rupture of lens capsule

Phacolytic glaucoma due to phacotoxic

meshwork blockage

Subluxation of lens

Glaucoma secondary to intraocular

hemorrhage Hyphema

Hemolytic glaucoma, also known as

erythroclastic glaucoma

Neovascular glaucoma

Traumatic glaucoma

Angle recession glaucoma: Traumaticrecession on anterior chamber angle

Postsurgical glaucoma

Aphakic pupillary block

Ciliary block glaucoma

Drug-induced glaucoma

Corticosteroid induced glaucoma

Alpha-chymotrypsin glaucoma.

Postoperative ocular hypertension from

use of alpha chymotrypsin.

Glaucoma of miscellaneous origin

Associated with intraocular tumors Associated with retinal detachments

Secondary to severe chemical burns of the

eye

Associated with essential iris atrophy

Toxic Glaucoma


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Documents

Glaucoma Diska