A case presentation on GLAUCOMA..pptx

GLAUCOMA-A case presentation on
GLAUCOMA.
Glaucoma is a group of eye conditions that damage the optic nerve. The optic nerve sends visual information from your eye to your brain and is vital for good vision. Damage to the optic nerve is often related to high pressure in your eye. But glaucoma can happen even with normal eye pressure.
There are four major types of glaucoma:
Open-angle glaucoma(If that system is blocked or isn't functioning well, the pressure inside the eye (intraocular pressure) builds, which in turn damages the optic nerve. With the most common type of glaucoma, this results in gradual vision loss. Glaucoma is a group of eye conditions that damage the optic nerve.
).
Angle-closure glaucoma(This form of glaucoma occurs when the iris bulges. The bulging iris partially or completely blocks the drainage angle. As a result, fluid can't circulate through the eye and pressure increases. Angle-closure glaucoma may occur suddenly or gradually.
), also called closed-angle glaucoma.
Congenital glaucoma.
Secondary glaucoma(Secondary glaucoma is glaucoma caused by any existing condition that raises internal eye pressure enough to damage the optic nerve. It can be treated both by managing the underlying condition that’s causing the issue and by taking medication or having surgery to lower the eye’s pressure.
).

1. A case presentation on GLAUCOMA Presented By: Nirbhay katiyar

2. Diagram of the eye:

3. GLAUCOMA: Glaucoma is  a group of eye conditions that damage the optic nerve . The optic nerve sends visual information from your eye to your brain and is vital for good vision. Damage to the optic nerve is often related to high pressure in your eye. But glaucoma can happen even with normal eye pressure. There are four major types of glaucoma: Open-angle glaucoma. Angle-closure glaucoma, also called closed-angle glaucoma. Congenital glaucoma. Secondary glaucoma.

4. 1-Open-angle glaucoma If that system is blocked or isn't functioning well, the pressure inside the eye (intraocular pressure) builds, which in turn damages the optic nerve . With the most common type of glaucoma, this results in gradual vision loss. Glaucoma is a group of eye conditions that damage the optic nerve.

5. Symptoms of open-angle glaucoma: No symptoms in early stages. Gradually, patchy blind spots in your side vision. Side vision also is known as peripheral vision. In later stages, difficulty seeing things in your central vision.

6. 2-Angle-closure glaucoma: This form of glaucoma  occurs when the iris bulges . The bulging iris partially or completely blocks the drainage angle. As a result, fluid can't circulate through the eye and pressure increases. Angle-closure glaucoma may occur suddenly or gradually.

7. Symptoms of angle closer glaucoma: Severe headache. Severe eye pain. Nausea or vomiting. Blurred vision. Halos or colored rings around lights. Eye redness.

8. 3- Congenital glaucoma: Primary congenital glaucoma (PCG) is a rare disease due to genetically-determined abnormalities in the trabecular meshwork and anterior chamber angle resulting in elevated intraocular pressure (IOP).

9. Symptoms of congenital glaucoma:   Excessive tearing. Light sensitivity . A large, cloudy cornea  (the normally clear front surface of the eye) .

10. 4- Secondary glaucoma: Secondary glaucoma is  glaucoma  caused by any existing condition that raises internal eye pressure enough to damage the optic nerve. It can be treated both by managing the underlying condition that’s causing the issue and by taking medication or having surgery to lower the eye’s pressure. Symptoms of Secondary Glaucoma: Patchy blind spots in your peripheral vision. Severe headache. Pain in the eyes. Nausea and vomiting. Visible halos around lights. Redness of the eyes.

11. Open angle glaucoma treatment: Ocular hypotensive drugs. Reduce ocular tension Beta blockers: Timolol Betaxolol Levobunolol Carteolol They decrease Aquous humor production. Contra indicated in Respiratory disease like Asthma.

12. α -Adrenergic Agonist: Apraclonidine Brimonidine prodrug ( clonidine ) Dipivefrine prodrug of Adrenaline. They increase Uveo scleral outflow. Prostaglandin Analogues: Latanoprost Travoprost Bimatoprost They also increase Uveo scleral outflow.

13. Carbonic anhydrase inhibitors: Acetazolamide Dorzolamide Brinzolamide They act by reducing production of Aquous humor. Miotics : Pilocarpine Physostigmine Ecothiophate Improve the tone of ciliary muscle. And also increase trabecular outflow .

14. 2-Drugs for angle closer glaucoma: Reduce pressure due to Ostotics : Mannitol Glycerol Acetazolamide (Carbonic anhydrase inhibitor) Pilocarpine ( Miotics ) Timolol ( beta-blockers) Iridotomy (Definitive treatment): Surgical Laser

15. CASE PRESENTATION:

16. Subjective Data: NAME: XYZ AGE: 60yrs SEX: Female DEPARTMENT: Orthopaedic ward DIET: Mix BODY TYPE: Endomorphs MARRITAL STATUS: Married OCCUPATION: Housewife ADDRESS: Jaipur DATE OF ADMISSION: 05/12/2022 DATE OF DISCHARGE: 07/12/2022

17. Chief complaints: Pain and redness in the left eye for 3 days. Marked dimness of vision in the same eye for 3 days.

18. History of present illness: According to the statement of the patient , she was reasonably alright 3 days back. Then she developed sudden severe eye ache , redness and watering on her left eye. She also experienced marked dimness of vision and haloes around light on left eye. It was also associated with headache. And few episodes of vomiting . With these complaints she attended in a local hospital and was treated with topical eye drops and oral medications. But the symptoms did not improve significantly. So she came to our hospital for better management.

19. Past ocular history: No history of use of Spectacles. No history of ocular trauma or surgery. Ocular medications: Timolol + Brimonidine BD Tab. Acetazolamide (500 mg) TDS General medication history: She is recently diagnosed as Hypertensive but has no history of- DM ASTHMA HYPERLIPIDIMIA MIGRAINE

20. General surgery history: She has significant general surgical history. Drug history: She is taking antihypertensive ( Amlodipine + Omlesertan ) after being diagnosed as hypertensive here. Allergic history: No significant systemic ,ocular or drug allergic history.

21. General Examination: Apperance : Ill looking. Body built & Nutritional status: Average Co-operative: Yes Anemia : Absent Cyanosis: Absent Jaundice : Absent BP: 180/110 mm of hg Pulse : 80 /min. Respiratory rate: 15 beats /min. Temperature: 98 ° F

22. Slit lamp ocular examination: R E L E Lid Normal Normal Conjuctiva Normal Ciliary Congestion Cornea Normal Hazy Ant. chamber Shallow Very Shallow Pupil Round ,Regular , Reactive Vertically oval , Mid dilated , Non-reactive Ant.chamber angle Narrow Could not be evaluated Fundus Macula Background retina Vessels Normal Was not visible

23. Ocular examination: 17.3 mmHg Intraocular Pressure 69.3 mmHg Systemic Examination: Respiratory system Gastro intestinal system Nervous system Renal system All other systems reveal no abnormality except cardio-vascular system as patient is hypertensive .

24. Provisional Diagnosis: Acute Congestive Glaucoma (Left eye). Differential Diagnosis: Phacomorphic Glaucoma . Acute Anterior Uveitis . Differential Diagnosis: UBM of anterior chamber angle.

25. Systemic investigations: CBC with ESR Serum creatinine . Fasting lipid profile. Plan of management: Medical therapy. Surgery Counselling Follow up

26. Pre operative day: 24.4 mmHg IOP 40.8mmHg Medication: Tab. Levofloxacine 750 mg Tab.Acetazolamide 250 mg Tab.Potassium Chloride 600 mg Tab.Amlodipine + Omlesartan 5/40 mg Difluprednate eye drop Levofloxacine ED Brimonidine + Timolol ED 2% Pilocarpine ED

27. Surgical Treatment: Trabeculectomy (Left eye) Surgical Peripheral iridectomy (Right eye).

28. 1 st Post operative Day: 12.3 mmHg Intraocular Pressure 4.5 mmHg 6/6 VA 6/9 Medication: Tab. Levofloxacine 750 mg Tab.Amlodipine + Omlesartan 5/40 mg Difluprednate eye drop Levofloxacine ED 2% Pilocarpine ED

29. 2nd Post operative Day: 8.5 mmHg Intraocular Pressure 4.9 mmHg 6/6 VA 6/6 Medication: Tab. Levofloxacine 750 mg Tab.Amlodipine + Omlesartan 5/40 mg Difluprednate eye drop Levofloxacine ED 2% Pilocarpine ED

30. Discharge medication: 12.2 mmHg Intraocular Pressure 17.3 mmHg 6/6 VA 6/6 Medication: Tab. Levofloxacine 750 mg Tab.Amlodipine + Omlesartan 5/40 mg Difluprednate eye drop Levofloxacine ED 2% Pilocarpine ED

31. Discussion on therapy: GENERIC NAME CLASS INDICATIONS MOA ADR Tab. Levofloxacine 750 mg Quinolone antibiotics used in the treatment of bacterial infections. It is also used in treating infections of the urinary tract, nose, throat, skin and lungs (pneumonia).  directly inhibits bacterial DNA synthesis. Nausea,vomiting , Diarrhea,stomach pain, Constipation, heartburn. vaginal itching. Tab.Amlodipine 5mg  calcium channel blocker  It lowers blood pressure by relaxing the blood vessels so the heart. preventing calcium from entering the cells of the heart and arteries. Swelling, fatigue, palpitations, and flushing. Tab. Omlesartan 40 mg angiotensin II receptor antagonists monotherapy for hypertension angiotensin -II receptor blocker to undermine the renin-angiotensin-aldosterone system. Feeling dizzy or tired, Headaches, flu-like symptoms, runny or stuffy nose, cough or bronchitis Pain in your back,

32. Generic name Class Indication MOA ADR Difluprednate eye drop corticosteroids  to treat eye swelling and pain after eye surgery. a topical corticosteroid indicated for the treatment of infammation and pain associated with ocular surgery. eye itching or irritation; blurred vision; watery eyes; Headache. 2% Pilocarpine ED cholinergic agonists  to reduce swelling and pressure inside the eye.  By directly stimulating these receptors, pilocarpine causes smooth muscles, such as the iris sphincter muscle and ciliary muscle, to contract. Chest pain. Diarrhea, fast, slow, or irregular heartbeat, Headache, nausea or vomiting.

33. Drug Interactions:

34. Pharmacist Interventions:

35. Patient Counselling :

36. Lifestyle Modifications:

37. Thank You!