GlaucomaGlaucoma
Definition & Epidemiology Definition & Epidemiology Anatomy & physiologyAnatomy & physiology POAGPOAG ACGACG Secondary glaucomaSecondary glaucoma ManagementManagement Quiz Quiz
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
A/C angle structuresA/C angle structures Schwalbe’s lineSchwalbe’s line TMW: fenistrated TMW: fenistrated
sheetsheet SSSS CBCB
TonometryTonometry
Contact tonometryContact tonometry
-Applanation tonometry-Applanation tonometry
Non-contact tonometry (NCT)Non-contact tonometry (NCT)
-Air puff -Air puff
Classification of glaucomas Cong vs acquiredCong vs acquired
Open vs closedOpen vs closed
Primary vs secondaryPrimary vs secondary
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)
Acute Angle Closure GlaucomaAcute Angle Closure Glaucoma
•Acute elevation of IOPAcute elevation of IOP•Angle closure by:Angle closure by:
-Pupillary block-Pupillary block
-Iris crowding-Iris crowding
Predisposing factors
SymptomsSymptoms
SuddenSudden ocular pain ocular pain Rapid loss of vision* Tearing Photophobia Headache Nausea Vomiting
SignsSigns Ciliary Ciliary congestioncongestion Mid dilated pupil Mid dilated pupil (due to pressure on (due to pressure on
ciliary nerves and vessles)ciliary nerves and vessles) High High IOPIOP Corneal edemaCorneal edema Closed angleClosed angle
Treatment of Acute Angle-Closure Glaucoma
• Hyperosmotic agentsIntravenous mannitol
B- Topical therapy• Pilocarpine • Beta-blockers
1. MedicalA-Systemic• CAI
Acetazolamide
2. Surgical YAG laser iridotomy
Primary Open Angle Glaucoma-POAG
Above 40yr usuallyAbove 40yr usually Bilateral Bilateral Asymptomatic in early stagesAsymptomatic in early stages
Pseudoexfoliation
Firillar material, Firillar material, similar to amyloidsimilar to amyloid
Deposition in the Deposition in the TMW….high TMW….high IOPIOP
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
-Trabeculectomy-Trabeculectomy
-Tube-shunt surgery-Tube-shunt surgery
-Cyclodestructive procedures-Cyclodestructive procedures
MedicalMedicalTopicalTopical
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
– Lid edemaLid edema– ConjunctivitisConjunctivitis
– FatigueFatigue– Drowsiness Drowsiness – Apnea Apnea
– bradycardiabradycardia– hypotensionhypotension
Glaucoma Drugs – Side EffectsGlaucoma Drugs – Side Effects
Adrenergic DrugsAdrenergic Drugs
GenericsGenerics– AcetazolamideAcetazolamide
(250 mg tabs, 500mg caps, (250 mg tabs, 500mg caps,
500 mg IV solution)500 mg IV solution)
BrandsBrands– DiamoxDiamox
Glaucoma DrugsGlaucoma Drugs
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)
Action:Action:– Reduce IOP by increasing the outflow Reduce IOP by increasing the outflow
through uveoscleral channelsthrough uveoscleral channels– Lowers IOP in 3- 4 hrs after instillationLowers IOP in 3- 4 hrs after instillation
GenericsGenerics– Latanaprost Latanaprost (0.005% Sol.)(0.005% Sol.)
BrandsBrands– XalatanXalatan
Glaucoma DrugsGlaucoma Drugs
Prostaglandin AnalogsProstaglandin Analogs
• MIOTICS (2% Sol.)
– Produce miosis (small pupil)
• Generics– Pilocarpine
Hydrochloride
Glaucoma Drugs
Drugs to Increase the Outflow
Generally used in emergency Generally used in emergency situation when rapid decrease of situation when rapid decrease of IOP is needed for AACG.IOP is needed for AACG.
Action:Action:– increased S. osmolarity :increased S. osmolarity :
drawing fluid out of the vit across drawing fluid out of the vit across vascular barriers.vascular barriers.
Glaucoma DrugsGlaucoma Drugs
Osmotic AgentsOsmotic Agents