4. Goals
1. Diagnose
2. Properly classify the type of glaucoma
3. Identify any primary aetiologies
4. Set a baseline for future comparison
5. Document findings necessary to develop a
treatment plan
6. Monitor the effects of treatment
5. • The whole child should be examined for signs
1. Orbital changes
2. Skin (neurofibromatosis, Sturge-Weber)
3. Other organ involvement indicating disease
associated with the glaucoma.
6. Anathesia IOP
• General anesthetics are known to have a potent effect
on IOP on both normal and glaucomatous eyes.
• Virtually all of the inhalational anesthetics are known
to depress the IOP within minutes of administration.
• Ketamine HCl slowly elevates the IOP as deeper
anesthesia is attained.
• The benzodiazepines do not appear to have a
significant effect on IOP when used in preoperative
doses.
7. So , what will happen..?
• Midazolam HCl (Versed) is often used as a
preoperative sedative in children, and in many
cases the child is sufficiently sedated with this
medication to perform quick IOP measurement
before the administration of an inhalational general
anesthetic.
• Such a measurement, with the child resting
comfortably but not under the influence of the
potent inhalational anesthetics, is probably the
most accurate.
8. Highly agitated ...... 🤔
• The anesthesiologist should be aware that it is
preferable for the surgeon to measure the IOP as
early as possible during the induction of general
anesthesia.
10. • Not of all these pieces of equipment are absolutely
necessary but each instrument does add to the
quality of examination.
• In short, do the best you can with what you have.
11. 1_ Calipers or ruler (ruler can also be used to check
accuracy of the caliper scale)
2_ Direct ophthalmoscope
13. 5_ Goniolens for examination of the angle and
perhaps the fundus - if it is a direct-viewing model,
with fluid for lens-cornea contact
6_ Pachymeter (not essential but very useful)
14. 7_ Eyelid speculum (handy, but not essential)
8_ Hand-held slit lamp or operating microscope
9_ Tonometer (Schiotz, Perkins, TONO-PEN or other
applanation device)
