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    Glaucoma

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    Acute glaucoma can be open-angle or angle-closure. Open-angle glaucoma is slowly progressive and asymptomatic initially, leading to peripheral vision loss over time. Angle-closure glaucoma causes sudden onset of pain, redness, headache, and blurry vision due to blocked drainage of aqueous humor. Treatment for open-angle glaucoma focuses on lowering intraocular pressure to stop progression, while angle-closure glaucoma requires emergency medical therapy to rapidly lower pressure and prevent vision loss. Both types can cause irreversible vision impairment or blindness if not treated properly.

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    Glaucoma

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    Nil Nil
    35 views9 pages
    Acute glaucoma can be open-angle or angle-closure. Open-angle glaucoma is slowly progressive and asymptomatic initially, leading to peripheral vision loss over time. Angle-closure glaucoma causes sudden onset of pain, redness, headache, and blurry vision due to blocked drainage of aqueous humor. Treatment for open-angle glaucoma focuses on lowering intraocular pressure to stop progression, while angle-closure glaucoma requires emergency medical therapy to rapidly lower pressure and prevent vision loss. Both types can cause irreversible vision impairment or blindness if not treated properly.

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    Acute glaucoma can be open-angle or angle-closure. Open-angle glaucoma is slowly progressive and asymptomatic initially, leading to peripheral vision loss over time. Angle-closure glaucoma causes sudden onset of pain, redness, headache, and blurry vision due to blocked drainage of aqueous humor. Treatment for open-angle glaucoma focuses on lowering intraocular pressure to stop progression, while angle-closure glaucoma requires emergency medical therapy to rapidly lower pressure and prevent vision loss. Both types can cause irreversible vision impairment or blindness if not treated properly.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    35 views9 pages

    Glaucoma

    Uploaded by

    Nil Nil
    Acute glaucoma can be open-angle or angle-closure. Open-angle glaucoma is slowly progressive and asymptomatic initially, leading to peripheral vision loss over time. Angle-closure glaucoma causes sudden onset of pain, redness, headache, and blurry vision due to blocked drainage of aqueous humor. Treatment for open-angle glaucoma focuses on lowering intraocular pressure to stop progression, while angle-closure glaucoma requires emergency medical therapy to rapidly lower pressure and prevent vision loss. Both types can cause irreversible vision impairment or blindness if not treated properly.

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    Acute Glaucoma

    By:
    Armaan Ashraf Ali Lambe
    V9070020
    Introduction
    Glaucoma is a group of eye dss assoc. with acute or chronic destruction of the optic nn with /out assoc. ^
    intraocular pressure (IOP) and irreversible loss of vision.

    If glaucoma is detected early and treated blindness can be prevented. Most patients with early glaucoma are
    asymptomatic. Significant amount of peripheral vision can be lost before the pt notices visual problems.

    The two main types are open-angle glaucoma and angle-closure glaucoma.

    Open-angle glaucoma accounts for 90% of all cases of glaucoma, is slowly progressive, and is initially often
    asymptomatic, but leads to bilateral peripheral vision loss over time With appropriate treatment that lowers IOP,
    progression can be stopped before severe damage occurs.

    Angle-closure glaucoma is characterized by the sudden onset of a painful, red, and hard eye in combination
    with frontal headache, blurry vision, and halos appearing around lights. Immediate initiation of medical therapy
    is crucial to rapidly decrease IOP and prevent vision loss.
    Epidemiology

    It is the 2nd leading cause of Blindness in adults.


    10% of pts have visual impairment
    5% of pts have blindness

    Open-Angle Glaucoma is more common than Angle-Closure


    Glaucoma.
    Pathophysiology
    Ciliary Body (near the Iris) produces Aqueous Humour, which then
    flows from posterior chamber via the pupil into the anterior chamber
    and then drains back into the venous system via the trabecular
    meshwork in the "Angle of the Anterior Chamber".

    This flow against resistance causes an IOP, between 10-21 mmHg.

    Anything that disrupts the flow and reabsorption of aqueous humour,


    will raise IOP and lead to optic nerve damage, and visual
    impairment.
    Open Angle Glaucoma
    A type of glaucoma characterized by a wide-open anterior chamber angle

    RFs: Age>40, DM, FamilyHx, Myopia.

    Patho: Clogging of the Trabecular Meshwork or reduced drainage > ^IOP


    > Vascular Compression > Ischemia of Optic Nerve > Progressive Visual
    Impairment

    Etiology: Clogging can happen due to Uveitis, Vitreous Hemorrhage or


    Retinal Detachment.

    CF: Asymptomatic initial to Bilateral, progressive loss of visual field


    (peripheral to central) and arcuate scotoma. Assoc. headaches and
    photophobia.
    Open Angle Glaucoma
    Dx:
    Slit-lamp exam of the anterior segment: Normal anterior chamber angle
    Tonometry: measure IOP (N 10-21mmHg),
    ^IOP in 40% of pts but not required for dx.
    Gonioscopy - r/o angle-closure glaucoma.
    Fundoscopy - cupping and pallor of optic disc, disc hemorrhage, or narrowing of optic disc.
    Perimetry – visual field testing to detect blind spots in the visual field.

    Staging:
    Early/Mild - No abnormal on std visual field
    Moderate - Abnormalities in 1 hemifield
    Advanced/Severe - both hemifields.

    Tx: indicated for all incl asymptomatic,


    1st line: Topical prostaglandins
    Alt: Topical Beta Blockers or Alpha-2 agonists
    Refractory: Carbonic anhydrase inhibitors.

    Surgical:
    For advanced disease
    Laser Trabeculoplasty - laser thermaly ablates the meshwork.
    Surgical Trabeculectomy
    Angle-Closure Glaucoma
    Sudden and sharp increase in intraocular pressure caused by an obstruction of aqueous outflow. IOP >30mmHg

    RFs: Shallow Anterior Chamber, Hyperopia/Farsightedness, Age, Eye injury, scarring, adhesions or hx of
    surgery

    Patho: Trabecular Meshwork gets blocked, less drainage of the aqueous humour and raised IOP.
    Primary - due to anatomical variation, narrow iridocorneal angle, shallow chamber depth,
    Secondary - due to acquired conditions,

    CFs: Unilater, Reddened, Severly Painful Eye, (hard on palpation)


    Frontal headaches, N/V
    Blurred Vision, Halos
    Cloudy Cornea
    Irregular, Unresponsive pupil.

    Dx: Emergency and requires quick diagnosis and Emergency Opthalmology referral,
    IOP >21mmHg (Tonometry), Narrow iridocorneal angle (Gonioscopy), Optic disc changes, Visual field testing

    Tonometry – indicated in all suspected pts; Gonioscopy


    Slit-lamp - evaluate anterior chamber - shallow, cloudy cornea, pupil dilation.
    Fundoscopy - assess optic disc damage.
    Angle-Closure Glaucoma
    Tx: It is an emergency. Rapid onset IOP decreasing meds and then definitive procedure.
    Direct Parasympathetomimetic: Pilocarpine
    Alpha-2 agonists: Apraclonidine
    Beta Blockers: Timolol
    Carbonic Anhydrase
    Refractory after 30mins: repeat upto 3 times then
    Systemic Hyperosmotic agent. (IV Mannitol, oral glycine or oral isosorbide)

    Surgical: Anterior chamber paracentesis


    Indication: Vision threathening elevation
    Procedure: controlled drainage of some of the aqueous humor.

    Surgical: Laser Peripheral Iridotomy


    Indication: All pts within 24-48hrs of acute attack
    References
    Amboss.Glaucoma

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