DIAGNOSIS AND MANAGEMENT OF GLAUCOMA

Dr. Nurfifi Arliani, SpM Fakultas Kedokteran UMY Yogyakarta

GLAUKOMA
THIEF OF VISION

What is the Glaucoma ?

Glaucoma

diseases : elevated intraocular pressure compression & atrophy N II & loss of visual field.
second caused of blindness in Indonesia

The

How is the mechanism of Glaucoma?

Immbalance between the production & out flow of aqueous humor Increase of intraocular pressure

Compression of optic nerve

Atrophy of optic nerve Blindness

Anatomy of the Eyeball

Anatomy of the angle of the anterior chamber

Hemodynamic of aqueous humor :

aqueous humor is produced by ciliary body
Outflow aqueous humor : 80% via Trabeculum meshwork 20 % uveoscleral pathway

Outflow aqueous humor : Produced by ciliary body COP pupil COA Trabeculum meshwork canalis Schlemm plexus venosus subconjungtiva

Intraocular pressure affected

optic nerve

Visual field of Glaucoma patient

Classifications of Glaucoma
Primary

open angle Glaucoma Primary closure angle Glaucoma

Secondary

open angle Glaucoma Secondary closure angle Glaucoma

Congenital

Glaucoma

Primary open angle Glaucoma

The etiology: obstruction of the outflow of aqueous humor in the trabecular meshwork Symptoms: - relentless bilateral chronic disease - good vision at the early stage - visual field defects - difficulty in activity - unable to see the side few - Blindness in the terminal stage

PRIMARY OPEN ANGLE GLAUCOMA

Sign :

No symptom Excavated disk (CD > 0,6) Visual field defect / Scotoma IOP > 21 mmHg

Visual field of the glaucoma patient

THERAPY :
1. Decrease the IOP with medications 20 50 %

2. Routine visual field examination every 6-12 months

3. Filtering operation

PRIMARY ACUTE CLOSURE-ANGLE GLAUCOMA

Red eye Decrease of visual acuity, See rainbow Painful of the eye, discomfort and fullness of the eye to a severe, prostrating pain that can radiate to the back of the head. Nausea, vomiting

PRIMARY ACUTE CLOSURE-ANGLE GLAUCOMA

Palpebra spasme Conjungtiva hyperemia Cornea oedema Narrow of the Anterior chamber Pupil wide Lens cloudy Papil not specific (oedema, pale) IOP >21 mmHg

Headache

Red eye of Glaucoma

Therapy;
1. Refer to hospital 2. Immediately decrease the IOP 3. Evaluate iridocornea angle, open ? 4. Operasi (iridotomy/filtering)

SECONDARY GLAUCOMA due to other disease SECONDARY OPEN ANGLE GLAUCOMA

Uveitis Lens hipermatur Steroid Trauma

Gejala: acute/chronic

SECONDARY CLOSURE ANGLE GLAUCOMA

Uveitis Lens Hypertrophy Tumor intraoculi Neovacularisasion angle

Sign of closure angle glaucoma

CONGENITAL GLAUCOMA New born Afraid of light hypersensitif Buphthalmos Cornea cloudy IOP >21 mmHg

Out flow facility insufficient

Therapy of Congenital Glaucoma:

Operation: 1. goniotomi 2. trabeculotomi 3. trabeculectomi Obat Short term

EARLY DETECTION

Routine check-up

Occure symptom

Ophthalmologist

Time of check-up ? (non glaucoma patient)

3

years : If any symptom of decreasing the visual acuity occure

year If: Glaucoma family Steroid consumption Diabetes Hypertensi Ever had trauma Myop & hypermetrop high

Examination
Optic Nerve IOP Out flow facility Ofthalmoscopi Tonometri Gonioskopi

Visual field

Perimetri

Ofthalmoscopy Direct

Tonometri Schiotz

Tonometri Aplanasi

Slit Lamp examination

Visual field examination

CONFRONTATION TEST

GLAUCOMA THERAPY

Medicamentosa
Aim:

Operatif

Decrease IOP

Safe IOP
How high ?

Principles therapy of glaucoma:

1. The higher IOP, the higher of the risk of damage risk 2. Any other factor beside IOP 3. Continous Follow-up 4. Complication & Fund 5. Remain good sight, with - minor complication - affordable fund

How to decrease IOP ?

1. Decrease the production of AH 2. Increase the out flow of AH 3. Damage the Ciliary Body 4. Flow the AH to other place (filtering operation)

What will happen with the unobey patient?

Recurrent IOP increase
Severe damage of Optic Nerve Blindness

Conclusion
Damage of the nerve in glaucoma The early detection is important since the damage is irreversible Therapy by decreasing IOP into safe level Obey the doctor suggest and disiplin with long-life medication may prevent of blindness

THANK YOU