GLAUCOMA PPT

IT CONTAINS ADEQUATE INFORMATION TO UNDERSTAND GLAUCOMA.

1. Presentation on
PRESENTATION ON
GLAUCOMA
PRESENTED BY:
AYESHA RUQSAR

2. CONTENTS:
INTRODUCTION.
ETIOLOGY.
PATHOPHYSIOLOGY.
GLAUCOMACLASSIFICATION.
CLINICALMANIFESTATION.
DIAGNOSIS.
TREATMENT.
REFERENCES

3. 
•Glaucomareferstoagroupof
ophthalmicdisorderscharacterized
byneuropathyoftheopticnerveand
progressivelossofretinalganglion
cells,
VISUAL
FIELD
LOSS
OPTIC
NERVE
DAMAGE
GLAUCO
MA
INCREASE
IOP
•Whichleadsto
permanent
deteriorationofthe
visualfieldeventually
leadtoblindness.

4. ETIOLOGY
•Alltypesofglaucoma–progressiveopticneuropathydueto
thedeathofretinalganglioncells(RGCs)
•RGCsdeathisinitiatedbyblockintransportofneurotrophins
frombraintoRGCs
damagingcascadeactivation
ApoptosisofRGCs
•RGCsdeath–lossofretinalfibers–opticneuropathy&visual
fielddefects

5. •Mechanicaltheory:
↑IOP–mechanicalstretchoflaminacribtosa–
axonaldeformation&alteredcapillaryblood
flow--↓neurotrophinstoreachRGC`s
(normal IOP pressure is 5-22mm/Hg)
•Pressureindependentfactors:
-Failureofautoregulation
-Vasospasm
-Systemichypotension
-Blood/fluidloss
•Excitotoxicitytheory:
glutamate,oxygenfreeradicals,nitricoxide.

6. Intraocularpressureisafunctionof
productionofliquidaqueoushumourby
theciliaryprocessesoftheeye,andits
drainagethroughthetrabecular
meshwork.Aqueoushumorflowsfrom
theciliaryprocessesintotheposterior
chamber,boundedposteriorlyby
thelensandthezonulesofZinn,and
anteriorlybytheiris.Itthenflows
throughthepupiloftheirisinto
theanteriorchamber,boundedposteriorly
bytheirisandanteriorlybythecornea.
Fromhere,thetrabecularmeshwork
drainsaqueoushumorviathescleral
venoussinus(Schlemm'scanal)
intoscleralplexusesandgeneralblood
circulation.
MECHANISM OF PRODUCTION OF AQUEOUS
HUMOUR AND ITS OUFLOW

8. PATHOPHYSIOLOGY
A-POAG :
• Increased IOP causes retinal ganglion cell axons
to undergo mechanical stress, alters axonal
protein transport, and decreases blood supply to
the retina and the optic nerve leading to tissue
ischemia.
• The level of IOP is related to the death of retinal
ganglion cell and optic nerve fibers.

9. B-PACG:
InvolvesTwomajormechanismsof
Mechanicalobstructionoftrabecular
meshworkbytheperipheralirisinclude
1-Pupillaryblock(morecommon)
2-Irisplateau.
•Bothofthesemechanismsresultinthe
occlusionofaqueoushumoroutflow
causingIOPelevationatextremelevels
thatcanleadtovisionlossinhrstodays.

10. GLAUCOMA CLASSIFICATION

11. CLINICAL MANIFESTATION
A-POAG: General
• POAG is usually bilateral with asymmetric disease
progression
Symptoms:
1. Loss of peripheral vision.
2. Presence of scotomata(blind spots) in vision field.
Signs:
Ophthalmoscopic examination may reveal
1.Opticnervehead(opticdisc)cupping.
2.Large cup-to-disc ratio.
3.Notching of the optic nerve head rim.
4.Splinterhemorrhages(usingaslit-lampbiomicroscope)

12. B-PACG: General
(Medical emergency due to high risk of vision loss)
• Unilateral in presentation , the other eye is at risk.
Symptoms
1.Ocular pain.
2.Red eye.
3.Blurry vision.
4.Halos around lights.
• Nausea/vomiting.
• Headache / Diaphoresis.
Signs
1. Cloudy cornea
2. Conjunctivalhyperemia.
3. Pupil semidilatedand fixed to light
4. Eye will be harder on palpation.a

13. DIAGNOSIS
Eyepressuretest(intraocular
pressure).
Anteriorchamberangleexam.
Opticangleexam.
Visualfieldtest.

14. TREATMENT :
1.NON PHARMACOLOGICAL
TREATMENT.
2.PHARMACOLOGICAL
TREATMENT.

15. Non
pharmacol
-ogical
treatment
1. Eat
healthy
diet
2. Maintain
good
health
3. Avoid
stress
4.Go for
aromatothe
rapy,
acupunctur
e.
5. Avoid
caffeine,
alcohol,
watching tv
etc.,.
6. Avoid
allergic
foods.
NON PHARMACOLOGICAL
TREATMENTS

16. PHARMACOLOGICAL TREATMENT
OphthalmicDrugsforGlaucomaLoweringIOPby
1-REDUCING PRODUCTION OFAQUEOUS
HUMOR:
β-Blockers. α2AdrenergicAgonists
CarbonicAnhydraseInhibitors.
2-DECREASINGTHERESISTANCETOOUTFLOW
OFAQUEOUSHUMORTHROUGHTRABECULAR
MESHWORK:
cholinergicsandcholinesteraseinhibitors.
3-IMPROVING THEOUTFLOW OFAQUEOUS
HUMOR:
prostaglandins(uveoscleraloutflow)
sympathomimetics(trabecularmeshworkand
theuveoscleraloutflow).

17. A.TOPICAL Β-ADRENERGIC BLOCKING
DRUGS
Includes:
1.Non-selective:Timolol,Levobunolol,Metipranolol&
Carteolol.
2.β1-Selective:Betaxolol.
-Dosing:1dropBID
-Sideeffects:
1-Bronchospasm.
2-Bradycardia.
3-Hypotension.
4-CHFexacerbation.
5-Maskhypoglycemia.
6-Tachyphylaxis(20%to50%ofpts)
.-Nasolacrimalocclusionisatechniquetodecreaseamountof
drugabsorbedsystemicallyanddecreasetheincidenceofside
effectsandimprovemedicationeffectiveness.
Contraindications
1-Asthma
2-COPD
3-Sinusbradycardia
4-2ndor3rddegreeheartfailure16
Betanololcan be used

18. B. A2-ADRENERGIC AGONISTS
-Includes: Brimonidine(more selective) & Apraclonidine.
-Brimonidine: (Effective long-term monotherapy/ adjunctive
therapy)
-Apraclonidine(Short-term use only due to high rate of
tachyphylaxis)
Used for prevention & tttof postsurgical IOP elevations.
-Dosing: 1 drop BID to TID.
-Side effects:
1-Blepharoconjunctivitis.
2-Foreign body sensation.
3-Papillary mydrasis(Apraclonidine).
4-Eyelid retraction(Apraclonidine).
5-Mild systemic hypotension and lethargy.
( Brimonidinepass BBB ).
Contraindications
1.hypersensitivity.
2.Patientsreceiving
MOAinhibiortherapy.

19. C. CARBONIC ANHYDRASE INHIBITORS
1-Topicalagents:
-Includes:DorzolamideandBrinzolamide.
-Dosing:1dropBIDwithbetablockersorTIDalone.
-CombinationofTimolol+Dorzolamideiscommonly
used
-Sideeffects:
1-Burning.
2-Stinging.
3-Itching.
4-Dryeyes.
5-Conjunctivitis
Contraindications
patientswithhistoryof
hypersensitivityto
sulphonamides.

20. 2-Orally-administeredCAIs:
-Includes:Acetazolamide,Dichlorphenamide,
andMethazolamide.
-Dosing:250-1000mgdaily,givenindivided
dosesforamountover250mg.
-Sideeffects:
1-Paresthesiaofhandsandfeet.
2-Hypokalemiaandhyponatremia.
3-Nephrolethiasisandrenalfailure.
4-Hepaticinsufficiency.
5-Blooddyscrasiasfrombonemarrow
suppression
Contraindications:
1-Hypokalemia.
2-Hyponatremia

21. D. CHOLINERGICS AND CHOLINESTERASE
INHIBITORS
1-CHOLINERGICS:
-Includes: Pilocarpineand Carbachol.
-Dosing:1–2 drops TID or QID.
-Used with caution for closed angle
-Side effects:(due to miosis)
1-Brow ache and headache.
2-Affect night vision.
3-Bradycardia at high conc.
4-Retinal detachment.
5-Lacrimation, myopia, blurred vision.
Contraindications:
1.Severemyopiatoavoid
detachment.
2.pregnancy

22. 2-CHOLINESTERASE INHIBITORS :
Includes: Echothiophateiodide &Demecarium
bromide.
-Irreversible AchEinhibitors e’ long durations of
action.
-Stop at least 1 week before general surgical
procedure.
Dosing: 1 drop BID.
Side effects:
1-Depletion of systemic cholinesterase and
pseudocholinesterase.
2-Cataracts: occur in 30–50% of elderly patients
using these drugs for at least 6 months.

23. E. PROSTAGLANDINS
Includes: Latanoprost, Bimatoprost, Travoprost.
-First-line alternatives to topical β-blockers.
-Patients required to lower IOP by greater than 25%.
-Lower IOP by 25% to 35% (Lower nocturnal IOP).
Dosing: 1 drop once a day at bedtime
Side effects:
1-Conjunctivalhyperemia.
2-Stinging on instillation.3-Inc. in iris pigmentation.
4-Hypertrichosis.
5-Eyelashes darkening.

24. F. SYMPATHOMIMET ICS
Includes: DIPIVEFRIN HCL , EPINEPHRINE.
-IOP is reduced by 20–25%.
-Last line agents due to their systemic S.E. Profile
Dosing:1 drop BID.
Intoleranceto ocular adverse effects leads to
discontinuation of epinephrine in 80% of patients.
Side effects:
1-Burning, tearing.
2-Reactive conjunctivalhyperemia.
3-Allergic blepharoconjunctivitis.
4-Mydriasis → Blurring of vision.

25. THANK YOU