Glaucoma
1. Open Angle
2. Closed Angle
3. Neovascular (diabetics, retinal v occlusion)
- new vascular membrane blocking irido-corneal angle
4. Pigment Dispersion Syndrome (PDS)
- Iris pigment peeling off and blocking irido-corneal angle
5. Pseudoexfoliation Syndrome (PXF)
- systemic disease. basement membrane like material deposited throughout body and irido-corneal angle
Definition
NOTE: IOP can be N to get glaucoma
Epidemiology
Clinical Features
Sx
Signs
Investigation
Management
Medical
Laser
Surgery
Source
Dr Tim Root, www.ophtobook.com, 2009
Dr Toh Tze' Yo 2014
2. Closed Angle
3. Neovascular (diabetics, retinal v occlusion)
- new vascular membrane blocking irido-corneal angle
4. Pigment Dispersion Syndrome (PDS)
- Iris pigment peeling off and blocking irido-corneal angle
5. Pseudoexfoliation Syndrome (PXF)
- systemic disease. basement membrane like material deposited throughout body and irido-corneal angle
Definition
- Progressive retinal ganglion cell loss
- Gradual optic disc cupping
- Resulting peripheral field deficit
NOTE: IOP can be N to get glaucoma
Epidemiology
- 3% Australians
- 1/10 over 80y
- 50% undiagnosed (early glaucoma no sx)
Clinical Features
Sx
- Referral from optometrist/ GP
- FHx
- gradual vague changes in vision (POAG) --> build up of waste products
- Acute red painful eye with loss of vision w n+v (closed angle glaucoma) --> iris touch lens
Signs
- Slit lamp exam+fundoscopy
- Visual field confrontation
Investigation
- Optic nerve head imaging (OCT)
- Visual field testing
Management
Medical
- Topical eyedrops
- dec aqueous production (alpha agonist, beta blockers, CA inhibitors)
- Inc aqueous outflow (prostaglandin analogues, parasympathomimetics)
- Oral (acetalozamide/ Diamox (CAI))
Laser
- Selective laser trabeculoplasty (SLT)
- Laser peripheral irdotomy (PI)
- Laser peripheral iridoplasty
- Diode laser cycloablation
Surgery
- Trabeculectomy
- Glaucoma drainage implants
- Others (non-penetrating drainage surgery, mini-implants (stents)
Source
Dr Tim Root, www.ophtobook.com, 2009
Dr Toh Tze' Yo 2014