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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_hypertension8/13/2019 Glaucoma Diska
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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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