Glaucoma

GLAUCOMA

1. GLAUCOMA MR. MOUNESH. D. BADIGER SENIOR TUTOR MEDICAL SURGICAL DEPARTMENT KAHER INSTITUTE OF NURSING SCIENCES, BELAGAVI, 16/04/2020 7:23:08 PM 1 MOUNESH

2. Relevant anatomy and physiology The canal permits fluid to drain out of the eye into the systemic circulation so a constant intraocular pressure is maintained. 16/04/2020 7:23:08 PM 2 MOUNESH

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4. GLAUCOMA (ocular hypertension) Definition: Glaucoma is a group of ocular disorders characterized by Increased IOP Cupping and atrophy of the optic nerve head Visual field changes 16/04/2020 7:23:08 PM 4 MOUNESH

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6. CLASSIFICATION ( By the anatomic size of the anterior chamber angle) Open – Angle Glaucoma ( wide) Angle – Closure Glaucoma 16/04/2020 7:23:08 PM 6 MOUNESH

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8. ETIOLOGY & RISK FACTORS Age Heredity Myopia Diabetes mellitus Ocular trauma Ocular surgery Topical & peri-ocular corticosteroids 16/04/2020 7:23:08 PM 8 MOUNESH

9. PATHOPHYSIOLOGY 16/04/2020 7:23:08 PM 9 MOUNESH

10. Due to etiological factors Increased IOP Compress and damage optic nerve It fails to carry visual information to the brain Results in loss of vision 16/04/2020 7:23:08 PM 10 MOUNESH

11. SIGNS & SYMPTOMS Eye Pain Gradual loss of peripheral vision followed by loss of vision in the end stage Blurred vision Rainbow halos around light Nausea vomiting sometimes, accompanied by abdominal pain 16/04/2020 7:23:08 PM 11 MOUNESH

12. Redness of the sclera & conjunctiva Increased IOP Tunnel Vision Difficulty to focusing on near or distant objects 16/04/2020 7:23:08 PM 12 MOUNESH

13. Squinting Or Blinking Red – Rimmed , Encrusted Or Swollen Lids Double Vision Excess Tearing Or Watery Eyes 16/04/2020 7:23:08 PM 13 MOUNESH

14. DIAGNOSTIC EVALUATION History collection Physical examination Tonometry:  Determine the intraocular pressure  16/04/2020 7:23:08 PM 14 MOUNESH

15. Gonioscopy : is using a goniolens together with a slit lamp or operating microscope to view the iridocorneal angle, or the anatomical angle formed between the eye's cornea and iris Opthalmoscopy : Visualization of the retina 16/04/2020 7:23:08 PM 15 MOUNESH

16. Perimetry Test : A visual field test is an eye examination that can detect dysfunction in central and peripheral vision 16/04/2020 7:23:08 PM 16 MOUNESH

17. Dilated Eye Exam: examine the health of the optic nerve and retina. Slit-lamp examination: 16/04/2020 7:23:08 PM 17 MOUNESH

18. MEDICAL MANAGEMENT Antiglaucoma medications Cholinergies : Decrease formation & increase outflow of aqeous humor . Widens trabecular meshworks . E.g. pilocarpine , carbachol . Anticholinergies : Contracts ciliary muscles, which facilitatets outflow of aqueous humor . E.g. Ecothiophate iodide, physostigmine . Adrenergic agonist: Inhibits aqueos production & facilitates outflow. E.g. Epinephrine, Divirfrin . 16/04/2020 7:23:08 PM 18 MOUNESH

19. Beta-Adrenergic Antagonists ( Sympathometics ): Reduces aquueous humor formation & may increase outflow.E.g . Tilmolo , Betaxolol . Carbonic anhydrase inhibitor s : Decreases aqueous production by inhibiting carbonic anhydrase in the ciliary body. E.g. Acetazolamide , Methozolamide . Hypersomatic agents: Movement of water from introcular structures to circulation via plasma osmolarity . E.g. Glycerine, Mannitol 16/04/2020 7:23:08 PM 19 MOUNESH

20. SURGICAL MANAGEMENT 16/04/2020 7:23:08 PM 20 MOUNESH

21. Laser procedure Laser Trabeculoplasty : It is done on an argon laser equipped slit lamp, using a Goldmann gonioscope lens mirror. Specifically, argon laser is used to improve drainage through the eye's trabecular meshwork, from which the aqueous humour drains. 16/04/2020 7:23:08 PM 21 MOUNESH

22. Argon & krypton peripheral iridoplasty is a useful procedure to eliminate appositional angle closure. The laser is applied at the iris periphery. Heat from laser creates iris stromal shrinkage and mechanically pulls away iris tissue from  trabecular meshwork. 16/04/2020 7:23:08 PM 22 MOUNESH

23. Laser iridotomy laser iridotomy is to allow an equalization of pressure between the anterior (front) and posterior (back) chambers of the eye by making a hole in the superior peripheral iris. 16/04/2020 7:23:08 PM 23 MOUNESH

24. Viscocanalostomy Viscocanalostomy  is a non-penetrating procedure aimed at increasing the outflow facility by creating significant morphologic changes at the trabecular meshwork level. It is an effective procedure in lowering intraocular pressure (IOP) in open-angle glaucomatous eyes. 16/04/2020 7:23:08 PM 24 MOUNESH

25. Filtering procedures Trephine: Step by step operative procedure to correct strabismus (resection of the right internal rectus muscle) and resection and advancement of right external rectus muscle. 16/04/2020 7:23:08 PM 25 MOUNESH

26. SCLERECTOMY This surgery works by building up new outflow pathways for the drainage of the aqueous humor while maintaining the integrity of the anterior chamber 16/04/2020 7:23:08 PM 26 MOUNESH

27. THERMAL SCLEROSTOMY 16/04/2020 7:23:08 PM 27 MOUNESH

28. TRABECULECTOMY Trabeculectomy :  This is achieved by making a small hole in the eye wall (sclera), covered by a thin trap-door in the sclera. 16/04/2020 7:23:08 PM 28 MOUNESH

29. FILTERING TUBES AND IMPLANTS Aqueous shunts or glaucoma drainage devices (GDD) are artificial filtering devices which lower the intraocular pressure (IOP) by draining aqueous humor to the external subconjunctival space. 16/04/2020 7:23:08 PM 29 MOUNESH

30. CYCLOCRYOTHERAPY  It is a procedure that employs temperatures as low as -112°F (-80°C) to destroy the ciliary body. Ablation, or destruction, of part of the ciliary body lowers the IOP by decreasing the fluid or aqueous humor within the eye and thus helping to control glaucoma. 16/04/2020 7:23:08 PM 30 MOUNESH

31. CYCLODIALYSIS Cyclodialysis  is the result of the separation of the longitudinal ciliary muscle fibers from the scleral spur, which creates an abnormal pathway for aqueous humor drainage that may lead to ocular hypotony . (Spatula) 16/04/2020 7:23:08 PM 31 MOUNESH

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33. COMPLICATION Blindness Post operative complications Corneal damage Haemorrhage Iritis Hypotony (Flat anterior chamber) Cataract formation Atrophy of the eyeball (phthisis bulbi) Cystoid macular oedema 16/04/2020 7:23:08 PM 33 MOUNESH

34. PROGNOSIS There is no cure for glaucoma Early detection and treatment maximize preservation of vision 16/04/2020 7:23:08 PM 34 MOUNESH

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