glaucoma diploma class presentation-1.pptx

Glaucoma

1. GLAUCOMA

2. GLAUCOMA Glaucoma is a group of disorders characterized by loss of visual field associated with cupping of the optic disc and optic damage. Or Is a condition characterized by optic neuropathy with gradual loss of peripheral vision and usually increased intra ocular pressure.

3. A disease entity characterized by Raised intraocular pressure (IOP) Disc cupping Visual Field Loss Presence of any two of the above will constitute the diagnosis of Glaucoma.

4. Anatomy and Physiology Aqueous produced by the Ciliary Body (CB) epithelium Outflow is from the Anterior Chamber angle of the eye Trabecular meshwork Schlemm Episcleral veins

5. Aqueous Outflow Physiology CB epithelium Posterior Chamber Anterior Chamber (through the Pupil) Trabecular Meshwork Schlemm Canal Episcleral Veins

6. RISK FACTOR Older people (aging). Race (black people). Family history (genetic). Decreased ocular perfusion pressure. Underlying condition like diabetes. Raised intra ocular pressure. Thinner corneas associated with increased risk. Myopia (short sightedness).

7. TYPES OF GLAUCOMA Open angle glaucoma. Angle closure / closed / narrow angle glaucoma.

8. OPEN ANGLE GLAUCOMA (most common) (The drainage angle formed by cornea and iris remain open, but the trabecular meshwork is partially blocked). Mostly asymptomatic and has adult onset. Usually bilateral History of gradual loss vision in affected eye or loss of visual field. Impaired dark adaptation Often suspected after seeing cupping of optic disc on routine fundoscopy or finding increased intra ocular pressure >21mmHg on screening.

9. Glaucoma

10. ANGLE CLOSURE GLAUCOMA/ CLOSED ANGLE GLAUCOMA (This occur when the iris budges forward to block/narrow the drainage angle formed by the cornea and iris). Sudden onset of severe pain. Nausea and vomiting Reddened conjunctiva Loss of vision in affected eye Severely elevated IOP

11. When palpated with a finger, the affected eye feels hard compared to another eye Semi dilated pupil Cloudy cornea Visual field narrowing Usually, unilateral Shallow anterior chamber. (severe headache, blurred vision, and halos around light)

12. OTHER TYPES OF GLAUCOMA Normal tension glaucoma: here the optic nerve becomes damaged even though the eye pressure is within normal range. Glaucoma in children: its possible for infants and children to have glaucoma. it may be present from birth or develop in first few years of life. Pigmentary glaucoma. Here pigment granular from your iris build up in the drainage channels slowing or blocking fluid exciting your eye.

13. NB: Elevated eye pressure is due to a buildup of a fluid (aqueous humor) that flows throughout the inside of your eye. This internal fluid normally drains out through a tissue called trabecular meshwork at the angle where the iris and cornea meet. When fluid is over produced or the drainage system doesn’t work properly, the fluid cannot flow out at its normal rate and eye pressure increased.

14. DIAGNOSIS Tonometry. Indirectly measures IOP. Visual field testing. Identifies the degrees of central visual field narrowing and peripheral vision loss. Fundoscopy. Identifies pallor and increased in the size and depth of optic cup on the optic disc. Gonioscopy. Used to measure the depth of the anterior chamber. Used to differentiate between open and closed glaucoma.

15. MANAGEMENT Aims. To arrest/ delay the progress of the disease (Not for visual impairment ) therapy is usually lifelong. Open angle glaucoma Timolol 0.5% eye drops given 1 drops 12 hourly. Closed angle glaucoma. This is a medical emergency that requires urgent reduction of IOP. Given mannitol 20% by slow IV infusion until IOP is reduced. (Normal 15 to 20mmhg) Tabs Acetazolamide 500mg stat then 250mg 6 hourly plus Timolol 0.5% drops 1 drop bid.

16. NOTE: Medicine cannot cure glaucoma but can help in controlling IOP and pressure vision indefinitely. Surgical intervention is indicated for clients with acute angle closure glaucoma and clients with chronic open angle glaucoma that cannot be affectively controlled with medicine. Avoid timolol eye drop in patients with asthma, heart block and controlled heart failure.

17. PREVENTION . Regularly dilated eye examination Know your family eye health history. Exercise safely Take prescribe eye drops regularly Wear eye protection.

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