Glaucoma 2

Glaucoma
Glaucoma
An optic neuropathy characterized by:
Elevated intraocular pressure Optic disk cupping Visual field loss
Intro. Aqueous Production & Flow. Pathophysiology. Assessment. Types. Medical Treatment. Surgical Treatment
Normal visual field
Shrinking vision
Advanced field loss
Tunnel vision
Raised intraocular pressure

Impaired outflow of aqueous resulting from: abnormalities within the drainage system of the anterior chamber angle (i.e. open-angle glaucoma) Impaired access of aqueous to the drainage system (i.e. closed angle glaucoma)
Physiology of the Aqueous Humor

Clear liquid that fills anterior and posterior
chambers of the eye Ultrafiltrate of plasma produced in the stroma of the ciliary process Volume: 250 uL, 2.5 uL/min Osmotic pressure: slightly higher than plasma Composition : like plasma but higher concentration of ascorbate, pyruvate and lactate & lower concentration of protein, urea, and glucose
Aqueous formation and flow

Ciliary body
Posterior chamber
Pupil
Anterior chamber
Trabecular meshwork Schlemms canal
Pathophysiology
Ganglion cell atrophy
- Major mechanism of visual loss in glaucoma - Leads to thinning of the inner nuclear and nerve layers of the retina and axonal loss in the optic nerve Optic disk becomes atrophic, with enlargement of the optic cup Iris and ciliary body also become atrophic and the ciliary processes show hyaline degeneration
Risk Factors for developing Glaucoma

Age (>40 years old) Females > Males Hyperope (+) Family history of glaucoma GIC1a (myocillin gene) in open angle gl Systemic disease: HPN, DM Trauma Underlying ocular conditions: ex. CRAO, phacolytic, uveitis Drugs, ex. steroids
Clinical Assessment
1. 2. 3. 4. Fundoscopy / Optic Disc Assessment Tonometry Gonioscopy Visual Field Evaluation
Optic Disk Assessment

Physiologic Cup
Normal central depression Size depends on the bulk of the fibers that form the optic nerve relative to the size of the scleral opening Hyperopic eyes scleral opening is small -> small optic cup
Optic Disk Assessment

Glaucomatous optic atrophy
Loss of disc substance; enlargement of optic disc cup Disc pallor in the area of cupping Concentric enlargement of the optic cup or preferential superior and inferior cupping with focal notching of the rim of the optic disc Retinal vessels on disc are displaced nasally bean pot cup Cup-disc ratio: ratio of cup size to disc diameter (>0.5 or significant asymmetry between the two eyes) Atrophy of nerve fiber layer (Hoyts sign)
Optic Disc Cupping:
Tonometry
Measurement of intraocular pressure (IOP) Normal pressure = 10-24 mmHg Types of Tonometry
Goldmann Applanation Tonometer measures the force required to flatten a fixed area of the cornea, gold standard Perkins Tono Pen portable Pneumomatotonometer irregular surface cornea Schiotz portable, measure corneal indentation produced by known weight
Applanation Tonometry
Gonioscopy
Clinical technique used to examine structures in the anterior chamber 4 structures:
Schwalbes line Trabecular meshwork Schlemms canal Ciliary body
Visual Field Exam:

Confrontation Test - Simplest - Used for screening purposes only
Goldmann Perimeter - Kinetic form of visual field testing
THANK YOU!

Glaucoma 2

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Glaucoma 2

Uploaded by

Copyright:

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Glaucoma

Elevated intraocular pressure Optic disk cupping Visual field loss

Normal visual field

Advanced field loss

Raised intraocular pressure

Physiology of the Aqueous Humor

Aqueous formation and flow

Risk Factors for developing Glaucoma

Optic Disk Assessment

Optic Disk Assessment

Optic Disc Cupping:

Visual Field Exam:

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