Glaucoma and its classifications.pptx

you can get information about the glaucoma and its possible all types, its signs and symptoms, its pathogenesis, and its treatment (with medicines and with surgery).
you will know that how it affects the eye and causes the visual filed defects.
you will know that how it occurs in children and causes loss of vision.

1. Glaucoma and its Classifications

2. What is glaucoma? A disease of the optic nerve. When damage to the optic nerve fibers occurs, blind spots develop; B lind spots usually go undetected until optic nerve is significantly damaged. Normal vision 2 Vision as it might be affected by glaucoma

3. G laucoma Pathophysiology of glaucoma revolves around the aqueous humour dynamics. The principal ocular structures concerned with it are: Ciliary body: A seat of aqueous production Angle of anterior chamber: It plays an important role in the process of aqueous drainage. Aqueous outflow system: It includes the trabecular meshwork, Schlemm’s canal, collector channels, aqueous veins and the episcleral veins

4. Glaucoma

5. Secretion of aqueous humour Ciliary body (posterior chamber) Route of Drainage Trabecular outflow (90%) Uveal-scleral outflow (10%) Aqueous production and drainage

6. Trabecular Outflow

7. Uveoscleral Outflow

8. Types of glaucoma Classification according to etiology * Primary glaucoma * Secondary glaucoma * Congenital - Primary congenital Infantile: present in first year of life Juvenile: present in late childhood

9. Types of glaucoma Classification according to appearance of the angle mechanisms cause impaired aqueous outflow * Open angle glaucoma * Closed angle glaucoma

10. Types of Glaucoma Normal-Tension Glaucoma

11. Congenital Glaucoma

12. Description A rare condition Manifests without associated anomalies Pathogenesis Maldevelopment of the angle structures Impaired aqueous outflow Raised IOP CONGENITAL GLAUCOMA

13. Pathogenesis Primary congenital glaucoma is due to failure or abnormal development of the trabecular meshwork Maldevelopment of the trabeculum including iridotrabecular junction ( trabeculo -dysgenesis) which is responsible for impaired aqueous outflow resulting in raised IOP. Primary congenital glaucoma

14. Trabeculo -dysgenesis is characterized by absence of the angle recess with iris having a flat or concave direct insertion into the surface. The iris may not completely separate from the cornea that the angle remains closed by persistent embryonic tissue. Pathogenesis

15. Etiology 10% show autosomal recessive inheritance with variable penetration Prevalence and genetic pattern 10% cases exhibit an autosomal recessive inheritance. Sex linkage is not common in inheritance, over 65% of the patients are boys. The disease affects only 1 child in 10,000 births.

16. True congenital glaucoma (40%) IOP becomes elevated intrauterine life and child is born with ocular enlargement. Infantile glaucoma (50%) It manifests prior to child’s third birthday. Juvenile glaucoma (10%) It manifests between 3-16 years. Congenital glaucoma classification

17. Symptoms Photophobia Lacrimation Blepharospasm Enlarged eyeball Eye rubbing Clinical Features

18. Corneal signs: Corneal oedema, Descemet’s breaks, and corneal enlargement more than 13mm diameter Sclera become thin and appears blue due to underlying uveal tissue. Iris may show iridodonesis (vibration of iris with eye movement) and atrophic patches in late stage Clinical Features

19. Lens becomes flat due to stretching of zonules and may even subluxated. Optic disc shows increased cup/disc ratio and atrophy specially after third year. IOP is invariably high. Clinical Features

20. ASSESSMENT Child may need an examination under the anesthesia History on lacrimation, photophobia, and blepharospasm Assess visual acuity and perform refraction to find out loss of vision Examine cornea for edema and opacity

21. Measure IOP with hand held Perkin’s applanation tonometer Measure corneal diameter. Perform a dilated fundus examination to evaluate the optic disc and retina. ASSESSMENT

22. Altered visual perception secondary to increased IOP and manifested as profound lacrimation, photophobia, corneal haze, and buphthalmos and loss of vision DIAGNOSIS

23. IOP will be controlled and bring down to normal. Lacrimation will be controlled. Photophobia and corneal haze will be eliminated. Prevent eye from loss of vision. EXPECTED OUTCOME

24. Counsel the child’s parents for urgent need of surgery Prepare them psychologically Check the ophthalmologic order of the management plan Topical beta-blocker ( timolol 0.25% to 0.50% b.i.d .). Intervention

25. Goniotomy It is the first choice of surgery (Clear cornea) Trabeculotomy Corneal clouding prevents visualization of the angle Failed repeated goniotomy Monitor IOP, optic disc, and corneal diameter on regular follow up . Intervention

26. GONIOTOMY TRABECULOTOMY MANAGEMENT OF CONGENITAL GLAUCOMA

27. Outcome criteria Cornea should be transparent and IOP should be maintained with in normal range EVALUATION