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Glaucoma: Camille N. Libranda

This document discusses glaucoma, including its epidemiology, etiology, pathophysiology, risk factors, signs and symptoms, diagnosis, and treatment. It notes that glaucoma is the third leading cause of blindness worldwide and the leading cause of irreversible blindness. There are two main types - open-angle glaucoma, which develops gradually, and closed-angle glaucoma, which has a sudden onset. Elevated intraocular pressure is a main risk factor. Treatment involves topical eye drops or surgery to lower pressure and prevent further optic nerve damage.

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Camille
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82 views

Glaucoma: Camille N. Libranda

This document discusses glaucoma, including its epidemiology, etiology, pathophysiology, risk factors, signs and symptoms, diagnosis, and treatment. It notes that glaucoma is the third leading cause of blindness worldwide and the leading cause of irreversible blindness. There are two main types - open-angle glaucoma, which develops gradually, and closed-angle glaucoma, which has a sudden onset. Elevated intraocular pressure is a main risk factor. Treatment involves topical eye drops or surgery to lower pressure and prevent further optic nerve damage.

Uploaded by

Camille
Copyright
© © All Rights Reserved
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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GLAUCOMA

CAMILLE N. LIBRANDA
EPIDEMEOLOGY 2015
International Agency of the
Prevention for Blindness

leading
cause of
irreversible
3rd leading cause of blindness blindness
EPIDEMIOLOGY
Philippines, 2017

14% Cataract

Retinopathy,
33% Maculopathy
, and others

25%
Errors of
Refraction

Glaucoma
28%
ETIOLOGY: Intra ocular
pressure (IOP)
no IOP is not constant;
diagn longer a
ostic it changes with
for gl criterion pulse, blood
auco
ma pressure, forced
expiration or
coughing, neck
compression, and
posture.

fie ld loss
o f visual
ris k
as e s with
incre g IOP
as in
incre
ETIOLOGY
Intraocular Pressure (IOP)
Drugs That May Induce or Potentiate IOP
OPEN-ANGLE GLAUCOMA CLOSED-ANGLE GLAUCOMA
Ophthalmic corticosteroids (high risk) Topical anticholinergics
Systemic corticosteroids Topical sympathomimetics
Nasal/inhaled corticosteroids Systemic anticholinergics
Fenoldopam Heterocyclic antidepressants
Ophthalmic anticholinergics Low-potency phenothiazines
Succinylcholine Antihistamines
Cimetidine (low risk) Ipratropium
Vasodilators (low risk) Benzodiazepines (low risk)
Theophylline (low risk)
PATHOPHYSIOLOGY
The Aqueous humor, dynamics, intraocular pressure (IOP), and Glaucoma

Typically, all of the chambers


of the eye are filled with fluid
composed by:

The anterior chambers which


includes the cornea and iris.
The posterior chamber which
is the narrow spaces between
the iris and the lens.
The vitreous chamber which is
the space between the lens
and the back of the eye
PATHOPHYSIOLOGY
The fluid flows Then, this
through the From the anterior meshwork allows
narrow space chamber, the the fluid to go
b/w the lens and fluid flows out of down into the
the back of the the eye through circular channel
iris, through the the trabecular called the canal
anterior meshwork. of Schlemm; and
chamber. finally, into the
aqueous veins.
Intraocular HTN =
pressure >21 mmHg
Glaucoma simulator vision
American Academy of ophthalmology
Two major types of glaucoma
Open-angle glaucoma
gradual increase of pressure in
the optic nerve

atrophy of the outer rim of the


nerve, resulting in the loss of
peripheral vision

continuous damage of the optic


nerve causing loss of central
vision as well

20 to 30 mm Hg range for years

“sneak thief of sight”


Closed-angle glaucoma
passage way of the aqueous humor
is narrow, making the lens pushed
against the iris

rapid physical blockage of the


trabecular meshwork may occur

causing severe abrupt onset of


pain, eye redness, blurry vision,
headaches, nausea visual haloes
General Classifications Of Glaucoma

Normal
Primary Secondary Congenital tension
Glaucoma Glaucoma Glaucoma glaucoma
(NGT)
Primary

Angle closure
Open angle

With Without
pupillary pupillary
block block
Secondary
Glaucoma

Open angle Angle closure

With pupillary block


Pre Post-
Trabecular Without pupillary
trabecular trabecular block
SIGNS AND SYMPTOMS
OPEN ANGLE GLAUCOMA CLOSED- ANGLE GLAUCOMA
• Slowly progressive and is • Experience intermittent
usually asymptomatic until the prodromal symptoms
onset of substantial visual field • Acute episodes produce
loss. symptoms (cloudy, edematous
• Central visual acuity is cornea; ocular pain; nausea,
maintained, even in late stages. vomiting & abdominal pain;
and diaphoresis)
• Noticeably signs : hyperemic
conjunctiva, cloudy cornea,
shallow anterior chamber, &
occasionally an edematous &
hyperemic optic disk
• IOP is 40 to 90 mm Hg when
symptoms are present.
RISK FACTORS
High eye pressure
Family history of glaucoma
African Americans
Especially Mexican Americans
Thin cornea
High myopia (very severe
nearsightedness)
Diabetes.
Eye surgery or injury.
High blood pressure
DIAGNOSIS

Simply looking for the optic nerve damage through


imaging and direct observation. In particular, the pressure
can make the outer rim of the nerve thin producing a
“cupping”.
DIAGNOSIS
DESIRED OUTCOME

The goal of drug therapy in patients with


glaucoma is to preserve visual function by
reducing the IOP to a level at which no
further optic nerve damage occurs.
PHARMACOLOGICAL
TREATMENT
The balance between the inflow and outflow of
aqueous humor determines IOP.
1. Inflow :
Increased by β -adrenergic agents
Decreased by α 2-, α -, and β -adrenergic blockers;
dopamine blockers; carbonic anhydrase inhibitors
(CAIs); and adenylate cyclase stimulators.
2. Outflow :
Increased by cholinergic agents.
Open-angle glaucoma tx
Risk factors:
 IOP greater than 25 mm Hg
 Vertical cup-disk ratio greater than 0.5
 Central corneal thickness less than 555
micrometers.
 Family history of glaucoma
 Black race
 Severe myopia
 Presence of only one eye.
PHARMACOLOGIC
TREATMENT
Topical Agents used for treatment of open-angle glaucoma
Closed-angle glaucoma tx
•Acute attack = osmotic agent and secretory inhibitor (e.g.,
β -blocker, α 2 agonist, latanoprost, or CAI), with or
without pilocarpine.
•Osmotic agents are used because they rapidly decrease
IOP
Examples include glycerin, 1 to 2 g/kg orally, and mannitol, 1 to 2
g/kg IV.
•Although traditionally the drug of choice, pilocarpine use
is controversial as initial therapy. Once IOP is controlled,
pilocarpine should be given every 6 hours until iridectomy
is performed.
Treatment of Closed-angle glaucoma

Topical corticosteroids can be used to reduce ocular


inflammation and synechiae.
Epinephrine should be used with caution because
it can precipitate acute closed-angle glaucoma,
especially when used with a β -blocker.
NON-PHARMACOLOGIC
TREATMENT

Trabeculoplasty

• laser treatment for glaucoma

Iridotomy

• produces a hole in the iris that permits aqueous flow

Implants

• a type of medical shunt used to help lower eye pressure


Thank you!
Other types of glaucoma
1. Secondary glaucoma
2. Pigmentary glaucoma
3. Pseudoexfoliative glaucoma.
4. Traumatic glaucoma
5. Neovascular glaucoma
6. Uveitic glaucoma

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