review of glaucoma

Glaucoma

Abdulrahman Al-Amri, MD

GlaucomaGlaucoma

Definition Definition Anatomy & physiologyAnatomy & physiology Types Types

– PrimaryPrimaryPOAGPOAGACGACG

- - Secondary glaucomaSecondary glaucoma ManagementManagement

Anatomy and physiology Anatomy and physiology Aqueous Humour Aqueous Humour

SecretedSecreted by the CB by the CB Carbonic anhydrase Carbonic anhydrase

enzyme is requiredenzyme is required Aqueous outflowAqueous outflow:: TMWTMW UveoscleralUveoscleral

Schlemm’s canal Schlemm’s canal

Venous circulationVenous circulation

Classification of glaucomas

Cong vs acquiredCong vs acquired

Open vs closedOpen vs closed

Primary vs secondaryPrimary vs secondary

TonometryTonometry

GonioscopyGonioscopy

Perimetry Perimetry

Congenital glaucomaCongenital glaucoma

TrabeculodysgenesisTrabeculodysgenesis Usually SporadicUsually Sporadic

Symp.Symp. PhotophobiaPhotophobia TearingTearing BlepharospasmBlepharospasm

SignsSigns

High IOPHigh IOPBuphthalmosBuphthalmosLarge corneaLarge corneaCorneal edema+/-Corneal edema+/-

Cupping Cupping (Normal C:D ratio =0.3)(Normal C:D ratio =0.3)

TreatmentTreatment

SurgicalSurgical

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 ACRefractive error

Predisposing factors

SymptomsSymptoms

SuddenSudden ocular pain ocular pain Rapid loss of vision* Tearing Photophobia Headache Nausea Vomiting

SignsSigns VAVA High High IOPIOP Corneal edemaCorneal edema Ciliary Ciliary congestioncongestion Mid dilated pupil Mid dilated pupil

– Pressure on ciliary nerves and vesslesPressure on ciliary nerves and vessles

Closed angleClosed angle

Management

• Hyperosmotic agents

Intravenous mannitol

A- Topical therapy

• Pilocarpine • Beta-blockers

B- Systemic• CAI

Acetazolamide

Surgical YAG laser iridotomy- macromedia

Primary Open Angle Glaucoma-POAG

Above 40yr usuallyAbove 40yr usually Bilateral Bilateral Asymptomatic in early stagesAsymptomatic in early stages Blurred vision & field loss are lateBlurred vision & field loss are late

Risk FactorsRisk Factors

Age Age FHFHSteroidsSteroidsMyopia Myopia DMDM

Primary Open angle GlaucomaPrimary Open angle GlaucomaPOAGPOAG

Mechanical Ischemic

IOP > 21 mmHg

Cupping

Open angle

Visual field loss

Primary Open Angle Glaucoma-POAG

ProgressionProgression

APDAPD

SECONDARY SECONDARY GLAUCOMAGLAUCOMA

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

Pseudoexfoliation

Firillar material, Firillar material, (similar to amyloid)(similar to amyloid)

Deposition in the Deposition in the TMW…….high TMW…….high IOPIOP

Phacomorphic glaucomaPhacomorphic glaucoma

Glaucoma Glaucoma Phacolytic VS PhacomorphicPhacolytic VS Phacomorphic

Glaucoma DrugsGlaucoma Drugs


Drugs to decrease Drugs to decrease the the productionproduction of of aqueous humor.aqueous humor.

Drugs to increase Drugs to increase the the outflowoutflow of of aqueous humor.aqueous humor.– Trabecular channelsTrabecular channels– Uveoscleral Uveoscleral

channelschannels

ManagementManagement

MedicalMedical

-Topical -Topical

-Systemic-Systemic Surgical Surgical ((Failure of medical Rx )Failure of medical Rx )

-Trabeculectomy-Trabeculectomy

-Tube-shunt surgery-Tube-shunt surgery

-Cyclodestructive procedures-Cyclodestructive procedures

Medical-topicalMedical-topical

ProductionProduction SympathomimeticsSympathomimetics

(adrenergic agonists)(adrenergic agonists) Beta blockersBeta blockers

OutflowOutflow Parasympathomimetics Parasympathomimetics

(Miotics-cholinergic ag)(Miotics-cholinergic ag) Prostaglandin analoguesProstaglandin analogues

– Allergic conjunctivitis– Punctate keratitis

– Bradycardia– Bronchospasm– Hypotension – libido– Depression

Glaucoma Drugs – Side Effects

Betablockers

• MIOTICS (2% Sol.)

–

• Generics– Pilocarpine

Hydrochloride

Drugs to Increase the Outflow

All miotics are packed in green cap bottles

ManagementManagement

MedicalMedical

-Topical -Topical

-Systemic-Systemic

MedicalMedicalSystemicSystemic

Carbonic anhydrase inhibitors

Hyperosmotic agents

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


Carbonic Anhydrase Inhibitors Carbonic Anhydrase Inhibitors (CAI’s)(CAI’s)

• 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)


Osmotic AgentsOsmotic Agents

Increased serum osmolarity..drawing fluid out of Increased serum osmolarity..drawing fluid out of the vit across vascular barriers.the vit across vascular barriers.

GenericsGenerics– Glycerol Glycerol (oral liquid)(oral liquid)

– Mannitol Mannitol (20% IV Sol.)(20% IV Sol.)


Osmotic AgentsOsmotic Agents

SurgicalSurgical

--TrabeculectomyTrabeculectomy

-Tube-shunt surgery-Tube-shunt surgery

-Cyclodestructive procedures-Cyclodestructive procedures

DefinitionEpidemiology Anatomy & physioPOAGACGSecondary glaucoma

review of glaucoma

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