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M.R Shoja MDShahid Sadoughi Medical Science

Yazd. Iran

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ANATOMY OF EYE

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GLAUCOMA

Glaucoma is the second leading cause of blindness in the world. In 2000 there were an estimated 66.8 million people with glaucoma , 6.7 million of whom had bilateral blindness secondary to glaucoma. Glaucoma has been definded as a progresssive optic neuropathy

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Glaucoma classification

Closed angle :- Primary- secondary

Open angle :- Primary - Secondary

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Acute angle closure glaucoma

- Rapid increase in pressure of eye

- In Asia is more common - 2-3 times more common in

women than men- Much higher in hyperopic

eyes

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Epidemiology:

1- Age2-Gender 3-Race4-Heriditary5-Refractive Error6-Seasonal Incidence

(10% of all glaucoma , 5-10% bilatesal)

Primary Angle Closure Primary Angle Closure Glaucoma (PACG)Glaucoma (PACG)

Eastern Asialess in black

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Precipitating factors

1-Mydriasis Darkness Medications Emotional upset

-2- Extreme Miosis

-3- Prone position

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Dramatic symptoms Severe eye pain nausea and vomiting Headache Blurred vision Haloes around light Profuse tearing Fix mid-dilated pupil

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Diminished vision

Ciliary flush , corneal Edema

Elevated Iop (40-75 mmHg )

Shallow Anterior Chamber

Dilated , vertically Oval nonreactive pupil.

Cell and Flare in Ac

Hyperemic Swollen optic disk

FindingsFindings

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Exams & Tests Gonioscopy

Tonometry

Biomicroscopy

Ophthalmoscopy Perimetry

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Treatment

B-adrenergic antagonist Timolol-adrenergic agonist : Apraclonidine Acetazolamid TrusoptHyper osmotic agent

Laser iriditomy PISurgical iridectomy

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Acute Angle Closure Glaucoma

Hx: severe ocular pain with nausea and vomiting Pupil mid- dilated and oval Blurred vision Coloured haloes around lights due to corneal

oedema Rx: emergency referral to ophthalmologist

Miotics beta ,)Pilocarpine(- blockers )Timoptic( Aqueous suppressors )Acetazolamide( Hyperosmotic agents )glycerol, Mannitol( Once attack is broken, laser iridotomy indicated

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Congenital glaucoma

1. Primary

2. Secondary (Sturg-weber )

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Primary congenital )Infantile glaucoma(

60% are diagnosed by 6 months

80% within first year 65% are male Bilateral in 70% cases Incidence being 1 in 25000

births

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Eye exam Buphthalmos

Corneal enlargement > 13mm

Corneal edema

Glaucomatous cupping

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Symptoms

Epiphora

Photophobia

Blepharospasm

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Differential diagnosis Birth trauma

Obstruction of lacrimal system

Congenital syphilis, rubella

Mucopolysaccahridoses

CHED

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Treatment

Surgical

1. Goniotomy

2. Trabeculotomy