Review of glaucoma
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Glaucoma is a group of eye diseases that damage the optic nerve and cause vision loss. It is often associated with an abnormally high pressure inside the eye. There are several types of glaucoma including primary open-angle glaucoma (POAG), angle-closure glaucoma (ACG), and secondary glaucoma due to other health conditions. Glaucoma is managed through medication, laser treatment, or surgery depending on the type and severity. The goal is to prevent further optic nerve damage and vision loss.
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Review of glaucoma
- 2. GlaucomaGlaucoma DefinitionDefinition Anatomy & physiologyAnatomy & physiology TypesTypes – PrimaryPrimary POAGPOAG ACGACG -- Secondary glaucomaSecondary glaucoma ManagementManagement
- 6. Anatomy and physiologyAnatomy and physiology Aqueous HumourAqueous Humour SecretedSecreted by the CBby the CB Carbonic anhydraseCarbonic anhydrase enzyme is requiredenzyme is required Aqueous outflowAqueous outflow:: TMWTMW UveoscleralUveoscleral Schlemm’s canalSchlemm’s canal Venous circulationVenous circulation
- 7. Classification of glaucomas Cong vs acquiredCong vs acquired Open vs closedOpen vs closed Primary vs secondaryPrimary vs secondary
- 12. Congenital glaucomaCongenital glaucoma TrabeculodysgenesisTrabeculodysgenesis Usually SporadicUsually Sporadic Symp.Symp. PhotophobiaPhotophobia TearingTearing BlepharospasmBlepharospasm
- 13. SignsSigns High IOPHigh IOP BuphthalmosBuphthalmos Large corneaLarge cornea Corneal edema+/-Corneal edema+/- CuppingCupping (Normal C:D ratio =0.3)(Normal C:D ratio =0.3)
- 15. Acute Angle Closure GlaucomaAcute Angle Closure Glaucoma Acute elevation of IOPAcute elevation of IOP Angle closure by:Angle closure by: -Pupillary block-Pupillary block Age AC Refractive error Predisposing factors
- 16. SymptomsSymptoms SuddenSudden ocular painocular pain Rapid loss of vision* Tearing Photophobia Headache Nausea Vomiting
- 17. SignsSigns VAVA HighHigh IOPIOP Corneal edemaCorneal edema CiliaryCiliary congestioncongestion Mid dilated pupilMid dilated pupil – Pressure on ciliary nerves and vesslesPressure on ciliary nerves and vessles Closed angleClosed angle
- 18. Management • Hyperosmotic agents Intravenous mannitol A- Topical therapy • Pilocarpine • Beta-blockers B- Systemic • CAI Acetazolamide
- 19. Surgical YAG laser iridotomy- macromedia
- 21. Primary Open Angle Glaucoma- POAG Above 40yr usuallyAbove 40yr usually BilateralBilateral Asymptomatic in early stagesAsymptomatic in early stages Blurred vision & field loss are lateBlurred vision & field loss are late
- 23. Primary Open angle GlaucomaPrimary Open angle Glaucoma POAGPOAG Mechanical Ischemic
- 24. IOP > 21 mmHg Cupping Open angle Visual field loss Primary Open Angle Glaucoma-POAG
- 31. NVG:NVG: – PDR :Proliferative diabetic retinopathyPDR :Proliferative diabetic retinopathy – CRVO:Central retinal vein occlusionCRVO:Central retinal vein occlusion – BRVO:Branch retinal vein occlusionBRVO:Branch retinal vein occlusion – OISOIS :Ocular ischemic syndrome:Ocular ischemic syndrome
- 32. Pseudoexfoliation Firillar material,Firillar material, (similar to amyloid)(similar to amyloid) Deposition in theDeposition in the TMW…….highTMW…….high IOPIOP
- 34. GlaucomaGlaucoma Phacolytic VS PhacomorphicPhacolytic VS Phacomorphic
- 37. Glaucoma DrugsGlaucoma Drugs Drugs to decreaseDrugs to decrease thethe productionproduction ofof aqueous humor.aqueous humor. Drugs to increaseDrugs to increase thethe outflowoutflow ofof aqueous humor.aqueous humor. – Trabecular channelsTrabecular channels – Uveoscleral channelsUveoscleral channels
- 38. ManagementManagement MedicalMedical -Topical-Topical -Systemic-Systemic SurgicalSurgical ((Failure of medical Rx )Failure of medical Rx ) -Trabeculectomy-Trabeculectomy -Tube-shunt surgery-Tube-shunt surgery -Cyclodestructive procedures-Cyclodestructive procedures
- 39. Medical-topicalMedical-topical ProductionProduction SympathomimeticsSympathomimetics (adrenergic agonists)(adrenergic agonists) Beta blockersBeta blockers OutflowOutflow ParasympathomimeticsParasympathomimetics (Miotics-cholinergic ag)(Miotics-cholinergic ag) Prostaglandin analoguesProstaglandin analogues
- 40. – Allergic conjunctivitis – Punctate keratitis – Bradycardia – Bronchospasm – Hypotension – libido – Depression Glaucoma Drugs – Side Effects Betablockers
- 41. • MIOTICS (2% Sol.) – • Generics – Pilocarpine Hydrochloride Drugs to Increase the Outflow
- 42. All miotics are packed in green cap bottles
- 44. MedicalMedical SystemicSystemic Carbonic anhydrase inhibitors Hyperosmotic agents
- 45. GenericsGenerics – AcetazolamideAcetazolamide (250 mg tabs, 500mg caps,(250 mg tabs, 500mg caps, 500 mg IV solution)500 mg IV solution) Usage:Usage: – 1-2 times daily1-2 times daily BrandsBrands – DiamoxDiamox Glaucoma DrugsGlaucoma Drugs Carbonic Anhydrase InhibitorsCarbonic Anhydrase Inhibitors (CAI’s(CAI’s((
- 46. • Ocular: – Allerg conjunctivitis Systemic: *Tingling sensation of hands & feet *Steven-johnson sx *Renl stone *GIT – Headache / fatigue – Dry mouth – Dec. libido, – Depression Glaucoma Drugs – Side Effects Carbonic Anhydrase Inhibitors (CAI’s)
- 47. Glaucoma DrugsGlaucoma Drugs Osmotic AgentsOsmotic Agents Increased serum osmolarity..drawing fluid out ofIncreased serum osmolarity..drawing fluid out of the vit across vascular barriers.the vit across vascular barriers.
- 48. GenericsGenerics – GlycerolGlycerol (oral liquid)(oral liquid) – MannitolMannitol (20% IV Sol.)(20% IV Sol.) Glaucoma DrugsGlaucoma Drugs Osmotic AgentsOsmotic Agents
- 49. SurgicalSurgical
- 50. --TrabeculectomyTrabeculectomy -Tube-shunt surgery-Tube-shunt surgery -Cyclodestructive procedures-Cyclodestructive procedures