acute glaucomam.r.shoja1 m.r shoja md shahid sadoughi medical science yazd. iran
TRANSCRIPT
ACUTE GLAUCOMA M.R.SHOJA 1
M.R Shoja MDShahid Sadoughi Medical Science
Yazd. Iran
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ANATOMY OF EYE
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GLAUCOMA
Glaucoma is the second leading cause of blindness in the world. In 2000 there were an estimated 66.8 million people with glaucoma , 6.7 million of whom had bilateral blindness secondary to glaucoma. Glaucoma has been definded as a progresssive optic neuropathy
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Glaucoma classification
Closed angle :- Primary- secondary
Open angle :- Primary - Secondary
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Acute angle closure glaucoma
- Rapid increase in pressure of eye
- In Asia is more common - 2-3 times more common in
women than men- Much higher in hyperopic
eyes
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Epidemiology:
1- Age2-Gender 3-Race4-Heriditary5-Refractive Error6-Seasonal Incidence
(10% of all glaucoma , 5-10% bilatesal)
Primary Angle Closure Primary Angle Closure Glaucoma (PACG)Glaucoma (PACG)
Eastern Asialess in black
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Precipitating factors
1-Mydriasis Darkness Medications Emotional upset
-2- Extreme Miosis
-3- Prone position
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Dramatic symptoms Severe eye pain nausea and vomiting Headache Blurred vision Haloes around light Profuse tearing Fix mid-dilated pupil
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Diminished vision
Ciliary flush , corneal Edema
Elevated Iop (40-75 mmHg )
Shallow Anterior Chamber
Dilated , vertically Oval nonreactive pupil.
Cell and Flare in Ac
Hyperemic Swollen optic disk
FindingsFindings
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Exams & Tests Gonioscopy
Tonometry
Biomicroscopy
Ophthalmoscopy Perimetry
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Treatment
B-adrenergic antagonist Timolol-adrenergic agonist : Apraclonidine Acetazolamid TrusoptHyper osmotic agent
Laser iriditomy PISurgical iridectomy
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Acute Angle Closure Glaucoma
Hx: severe ocular pain with nausea and vomiting Pupil mid- dilated and oval Blurred vision Coloured haloes around lights due to corneal
oedema Rx: emergency referral to ophthalmologist
Miotics beta ,)Pilocarpine(- blockers )Timoptic( Aqueous suppressors )Acetazolamide( Hyperosmotic agents )glycerol, Mannitol( Once attack is broken, laser iridotomy indicated
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Congenital glaucoma
1. Primary
2. Secondary (Sturg-weber )
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Primary congenital )Infantile glaucoma(
60% are diagnosed by 6 months
80% within first year 65% are male Bilateral in 70% cases Incidence being 1 in 25000
births
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Eye exam Buphthalmos
Corneal enlargement > 13mm
Corneal edema
Glaucomatous cupping
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Symptoms
Epiphora
Photophobia
Blepharospasm
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Differential diagnosis Birth trauma
Obstruction of lacrimal system
Congenital syphilis, rubella
Mucopolysaccahridoses
CHED
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Treatment
Surgical
1. Goniotomy
2. Trabeculotomy