glaucoma_description_and_case_study.pptx

Glaucoma is one of the leading causes of irreversible blindness worldwide, often progressing silently until significant vision loss has occurred. This presentation provides a clear overview of the disease—covering basic anatomy, aqueous humor dynamics, and what happens when drainage problems arise.

You’ll learn about the different types of glaucoma:

-Primary Open Angle Glaucoma (POAG): The most common, gradual, and often symptom-free until late stages.

-Primary Angle Closure Glaucoma (PACG): A medical emergency with sudden pain, redness, and vision loss.

-Normal Tension Glaucoma (NTG): Damage occurs even with normal eye pressure.

-Secondary & Congenital Glaucoma.

The slides highlight clinical features, risk factors, diagnosis methods (tonometry, gonioscopy, OCT, visual fields), and management strategies—from medications (like prostaglandins and beta-blockers) to advanced surgical interventions (trabeculectomy, MIGS, drainage implants).

Two real-world case studies are included, demonstrating how glaucoma presents in patients and how timely diagnosis and treatment can preserve sight.

Key takeaway: Glaucoma cannot be fully prevented, but early detection and consistent management can slow progression and save vision.
✔️ Regular eye check-ups, especially after 40
✔️ Awareness of family history and risk factors
✔️ Strict compliance with prescribed treatment

This presentation is designed for optometry and medical students, eye-care professionals, and anyone interested in understanding how glaucoma works, why it’s dangerous, and what can be done to fight against it.

1. Glaucoma: The Silent Thief of Sight Presented by: GNANAMMAL ( B.Optom 3rd Year) INSTITUTE OF MANAGEMENT STUDY

2. BASIC ANATOMY

3. AQUEOUS HUMOR

4. WHAT IF THERE IS DRAINAGE PROBLEM?

5. A group of progressive optic neuropathies Characterized by optic nerve damage and visual field loss Usually associated with raised IOP (but can occur with normal IOP too) What is Glaucoma?

6. 1.Primary Primary Open Angle Glaucoma (POAG) Primary Angle Closure Glaucoma (PACG) Normal Tension Glaucoma (NTG) 2.Secondary – trauma, uveitis, lens, neovascular 3.Congenital Classification:

7. Open Angle Glaucoma Most common type Gradual, painless, bilateral Risk factors: Age > 40, family history, myopia, diabetes Clinical: Raised IOP, optic disc cupping, peripheral visual field loss Often asymptomatic until late

8. Closed Angle Glaucoma Sudden rise of IOP due to blocked drainage angle Symptoms: Severe ocular pain, redness, halos, headache, nausea, vomiting Signs: Mid-dilated pupil, corneal edema, conjunctival congestion Ophthalmic emergency

9. Normal Tension Glaucoma Optic nerve damage and field loss despite normal IOP Risk factors: Vascular dysregulation, low BP, migraine, ischemia More common in Asian population Needs careful diagnosis

10. Cupping of the optic disc

11. Diagnosis Tonometry (IOP measurement) Gonioscopy (angle evaluation) Fundus exam – optic disc cupping Visual field testing – tunnel vision, arcuate scotomas OCT – retinal nerve fiber layer (RNFL) thinning

12. Medical: Prostaglandin analogs (Latanoprost) – 1st line(POAG) Beta blockers (Timolol) Carbonic anhydrase inhibitors Miotics (Pilocarpine in PACG) Laser/Surgery: Laser trabeculoplasty / iridotomy Trabeculectomy Minimally Invasive Glaucoma Surgery Glaucoma Drainage Implants Management

13. CASE STUDY Case-1

14. Patient Name: XYA Age/Sex: 56/M Date: 20-08-2025 Reason for visit: First eye check. Night glare. Occasional brow ache for 6 months. History: No prior eye exams. No trauma or steroid use. HTN ×6 yrs (Amlodipine 5 mg). Father had high eye pressure. No allergies. Non-smoker.

15. Exam: VA (pinhole): 6/6 OD, 6/6 OS Refraction: −1.25 DS OU, +2.50 DS N6 Pupils/EOM: Normal, no RAPD Slit lamp: Clear cornea, deep quiet AC, early NS 1+ OU IOP (Goldmann, 10:30 a.m.): 26 OD / 24 OS (mmHg) CCT (µm): 520 OD / 515 OS Gonioscopy: Shaffer 3–4, TM seen 360°, no PAS OU Optic disc: OD C/D 0.7V with inferior rim thinning; OS C/D 0.6, rims intact Macula/periphery: WNL OU

16. Tests (baseline) HVF 24-2: OD superior nasal step (MD −3.2 dB); OS essentially full OCT RNFL/GCIPL: Inferior thinning OD; OS borderline inferior Disc photos taken Impression Early POAG OD. Fellow eye: glaucoma suspect. Thin corneas increase risk. Management Plan Start Latanoprost 0.005% 1 drop at night OU Target IOP: ≤18 mmHg Teach drop technique + punctal occlusion Follow-up 6 weeks for IOP check and tolerance → then 3–4 monthly if stable. Repeat OCT + fields at 6 months, then yearly or sooner if change.

17. CASE STUDY Case-2

18. Name: Mrs. XYZ Age/Sex: 54-year-old female Occupation: School teacher Chief Complaints OD (Right Eye): Severe pain, redness, blurred vision, and colored halos around lights for the past 10–12 hours, associated with nausea and headache. OS (Left Eye): Occasional blurring of vision and mild headache for the past few weeks. History Ocular History: no trauma or ocular surgery Family History: Positive (elder sister diagnosed with angle closure glaucoma) Medical History: Hypertension since 2 years(controlled on medication), no history of diabetes Allergies : Not aware of PGP: Reading Glasses: +2.25DS

19. Initial Management: Acute Attack (OD): IV Mannitol 20% 250 mL stat Oral Acetazolamide 500 mg stat, then 250 mg QID Topical Timolol 0.5% BD, Pilocarpine 2% QID, and Prednisolone acetate 1% QID OS (Prophylaxis): Timolol 0.5% BD started

20. Investigations: 1. OCT RNFL: OD: Superior & inferior thinning OS: Early superior thinning 2. Visual Field Testing (after stabilization): OD: Superior arcuate defect OS: Early nasal step 3. Anterior Segment OCT (AS-OCT): OU :Narrow angles

21. Day 2: Laser Intervention Bilateral Laser Peripheral Iridotomy (LPI) performed after OD corneal edema cleared .

22. Follow-up Visit 1 (1 Week Post LPI) Symptoms: Pain and halos resolved Continue Timolol OU, taper steroid OD.

23. Follow-up Visit 2 (3 Months Post LPI) Continue Timolol OU Monitor every 3–4 months patient counselled on adherence and early reporting of symptoms

24. Final Diagnosis: Primary Angle Closure Glaucoma OD: Advanced OS: Early stage

25. Is Glaucoma Preventable? No absolute prevention → as exact cause is not fully understood But progression can be slowed if detected early Why not preventable? -Often asymptomatic in early stages → late diagnosis -Damage to optic nerve is irreversible

26. Take Home Message Regular eye check-ups (especially after 40 yrs or if high risk) Family history → early screening Compliance with treatment to maintain vision

27. THANK YOU!