Glaucoma powerpoint presentation

1. GLAUCOMA
DR. EQBAL HOSSAIN
REGISTRER OF OPHTHALMOLOGY.

2. DEFINITION
• Glaucoma can be defined as a group of diseases that
have a common characteristic of progressive optic
neuropathy with corresponding characteristic visual
field defect where IOP is an important risk factor.

3. OPTIC NERVE HEAD (OPTIC DISC)

4. DISC IN GLAUCOMA

5. PROGRESSIVE ENLARGING CUP

6. DISC HAEMORRHAGE

7. LAMILLAR DOT SIGN

8. PERIPAPILLARY ATROPHY

9. NERVE FIBRE LAYER DEFECT

10. DISC IN GLAUCOMA

11. CHANGES OF DISC IN GLAUCOMA
1. Increased cup disc ratio.
2. Thinning of NNR.
3. Nasal shifting of blood vessels.
4. Double annulation of blood vessel- Bayoneting sign.
5. Laminar dot sign.
6. Disc hemorrhage.
7. Peripapillary atrophy.

12. VISUAL FIELD DEFECT IN GLAUCOMA

13. VISUAL FIELD DEFECT IN GLAUCOMA
• Generalised depression of sensitivity.
• Isolated paracentral scotoma.
• Seidel’ scotoma.
• Roenne’s nasal step.
• Arcuate scotoma.
• Double arcuate or ring scotoma.
• Tubular field.
• Only temporal island of vision.
• Total field loss

14. INTRA OCCULAR PRESSURE
• It is the lateral pressure exerted on the outer coat of eyeball by intraocular
contents specially the aqueous humour.
• Normal range : 11 – 21 mmHg.
• In glaucoma the raised IOP is due to aqeous outflow obstruction.

15. AQUEOUS PRODUCTION & DRAINAGE
PATHWAY
• Formed in the ciliary region
• Flows from posterior chamber to anterior chamber
through the pupil
• Angle of the anterior chamber 
• Trabecular meshwork
• Schlemm’s canal
• Aqueous veins
• Episcleral venous plexus.

16. AQUEOUS PRODUCTION & DRAINAGE
PATHWAY

17. MECHANISM OF RAISED IOP

18. MECHANISMS OF ANGLE-CLOSURE
GLAUCOMA:
• Building up of aqueous in posterior chamber.
• Forward bowing of the peripheral iris,resembling as ‘iris bombe’.
• Closure of the anterior of the anterior angle.
• Sharp rise in interocular pressure

19. STRUCTURE OF ANTERIOR CHAMBER ANGLE
• Schwalbe line.
• Trabecular meshwork
• Anterior trabecular meshwork.
• Posterior trabecular meshwork- Schlemm canal.
• Scleral spur.
• Ciliary body.
The process of examining the angle – Gonioscopy.
Instrument – Gonioscope.

20. ACUTE ANGLE CLOSURE GLAUCOMA
• Is an ophthalmic Emergency.
• Definition: Acute high rise of IOP due to acute angle clouser is known as Acute
angle clouser glaucoma.

21. ACUTE ANGLE CLOSURE GLAUCOMA
• Risk factors:
• Age: 4th – 5th decade.
• Sex: Female : Male = 4: 1
• Personality: Emotional & nervous people.
• Family history: Usually positive.
• Eye: Short axial length with shallow AC
• Refractive status: Hypermetropic.

22. ACUTE ANGLE CLOSURE GLAUCOMA
• Precipitating factors:
• Watching television in darkened room.
• Reading prolonged time.
• Acute emotional stress
• Pharmacological mydriasis.
• Drugs: Topiramate, cold remedies.

23. ACUTE ANGLE CLOSURE GLAUCOMA
• Symptomes:
• Acute intense unbearable pain in eye.
• Severe headache.
• Nausea & vomiting.
• Marked dimness of vision
• Redness
• Lacrimation.
• Halos around the light.

24. ACUTE ANGLE CLOSURE GLAUCOMA
• Signs:
• Visual acuity: markedly decreased.
• Eye lid: oedematous.
• Eye ball: tender & stony hard.
• IOP: very high, usually > 50 mmHg.

25. CILIARY CONGESTION

26. CORNEAL OEDEMA

27. VERTICALLY OVAL MIDDILATED PUPIL

28. SHALLOW ANGLE

29. INCREASED CORNEAL THICKNESS

30. GONIOSCOPIC ANGLE STATUS

31. RESOLVED STAGE OF APACG

32. ACUTE ANGLE CLOSURE GLAUCOMA
• Treatment :
• Hospitalization
• Initial treatment:
• Patient is advised to lie in supine position.
• Acetazolamide 500mg orally.
• Topical Timolol 0.5%, Prednisolone 1% one drop each in 5 minutes interval.
• Topical pilocarpine 2% one drop in each eye and ½ hourly in affected eye until
constrict.
• Analgesic – NSAIDS
• Antiemetic.

33. ACUTE ANGLE CLOSURE GLAUCOMA
• If IOP does not fall significantly(In registent case)
• 50% glycerol orally or 20% mannitol I/V is given.
• Topical 50% glecerol to improve corneal oedema.

34. • Further treatment( after 48 hours): after gonioscopy
• LPI – if PAS is < 50%
• Trabeculectomy – if PAS is >50%
• LPI in fellow eye.

35. THANK YOU