Pupil block glaucoma

Pupil block glaucoma

1. Glaucoma
Prof. Dr. Tehseen Sahi
Chairman Department of
Ophhalmology: KEMU

2. Aqueous flow
Ciliary epithelium
Posterior chamber
through pupil
Anterior chamber
Trabecular meshwork
Canal of schlemn

Aqueous veins venous circulation

3. Aqueous flow

5. Angle of anterior chamber
Iris process
Scleral spur
Schlemn canal
Trabeculum
Schwalbe line

6. Sites of Obstruction

7. Primary glaucoma
Pupil block (angle closure)
Open angle

8. Primary glaucomas
Pupil block
Person
Young
Female
Idealistic
High strung
Open angle

Person
ordinary

9. Primary glaucomas
Pupil block
Eye
Small
Hypermetropic
Shallow AC
Angle narrow
Open angle
Eye

Average

10. Presentation
Pupil block
ACUTE
SUDDEN, MARKED

PAIN

LOSS OF VISION

CONGESTION

GENERAL EFFECTS
Open angle
SLOW
GRADUAL

11. TREATMENT
Pupil block
SURGICAL
Open angle
MEDICAL

12. PROGNOSIS
Pupil block
VERY GOOD
Open angle
RELATIVELY
POOR

13. Pupil Block Glaucoma
MECHANISM OF ATTACK
(Mid-Dilated Pupil)
Increase in physiological pupil blockIncrease in physiological pupil block

14. Pupil Block Glaucoma
MECHANISM OF ATTACK
(Mid-Dilated Pupil)
Dilatation of pupil renders peripheral iris more flaccid
Increased pressure in posterior chamber causes iris bombe

15. Pupil Block Glaucoma
MECHANISM OF ATTACK
(Mid-Dilated Pupil)
Angle obstructed by peripheral iris and rise in IOP

16. Pupil block glaucoma

17. Pupil block glaucoma
Stages
Prodromal stage
Stage of constant instability
Acute congestive glaucoma
Ch. Congestive glaucoma
Absolute glaucoma

18. Constricted Pupil
Area of contact ……. More
Force of contact …… Less

19. Dilated
No Contact
No Force

20. Mid Dilated Pupil
Area of Contact …….. Less
Force of Contact …….. More

21. Pupil block glaucoma
(Mid Dilated Pupil)
Prodromal stage (mechanism)
Tense person sitting in dark area
Pupil mid-dilated
Firm Contact between Loose Iris
iris and lens.
Pupil Block
Iris bombe
Angle closure
Increased I.O.P

22. Mid Dilated Pupil
Area of Contact …….. Less
Force of Contact …….. More

23. Pupil Block Glaucoma
MECHANISM OF ATTACK
(Mid-Dilated Pupil)
Increase in physiological pupil block
Increase in physiological pupil block

24. Pupil Block Glaucoma
MECHANISM OF ATTACK
(Mid-Dilated Pupil)
Dilatation of pupil renders peripheral iris more flaccid
Increased pressure in posterior chamber causes iris bombe

25. Pupil Block Glaucoma
MECHANISM OF ATTACK
(Mid-Dilated Pupil)
Angle obstructed by peripheral iris and rise in IOP

26. Pupil block glaucoma
Prodromal stage
Features

Mild headache

Colored haloes

27. Pupil block glaucoma
Prodromal stage
Patient comes to bright light or goes to
sleep
Pupil constricts
Attack finished

28. Pupil block glaucoma
Stage of constant Instability
Prodromal attacks
More frequent More prolonged
Mechanism same.

29. Mid Dilated Pupil
Area of Contact …….. Less
Force of Contact …….. More

30. Pupil Block Glaucoma
MECHANISM OF ATTACK
(Mid-Dilated Pupil)
Increase in physiological pupil block
Increase in physiological pupil block

31. Pupil Block Glaucoma
MECHANISM OF ATTACK
(Mid-Dilated Pupil)
Dilatation of pupil renders peripheral iris more flaccid
Increased pressure in posterior chamber causes iris bombe

32. Pupil Block Glaucoma
MECHANISM OF ATTACK
(Mid-Dilated Pupil)
Angle obstructed by peripheral iris and rise in IOP

33. Pupil block glaucoma
Acute congestive glaucoma
Mechanism same
Attack cannot be abolished spontaneously
Features

Acute ,marked pain

Redness

Loss of vision

34. Mid Dilated Pupil
Area of Contact …….. Less
Force of Contact …….. More

35. Pupil Block Glaucoma
MECHANISM OF ATTACK
(Mid-Dilated Pupil)
Increase in physiological pupil block
Increase in physiological pupil block

36. Pupil Block Glaucoma
MECHANISM OF ATTACK
(Mid-Dilated Pupil)
Dilatation of pupil renders peripheral iris more flaccid
Increased pressure in posterior chamber causes iris bombe

37. Pupil Block Glaucoma
MECHANISM OF ATTACK
(Mid-Dilated Pupil)
Angle obstructed by peripheral iris and rise in IOP

38. Pupil block glaucoma
Acute congestive glaucoma
Signs

Lid swelling

Ciliary congestion

Corneal edema

Shallow AC

Angle closed

Very high I.O.P

Pupil dilated and oval

39. Pupil block glaucoma
Severe corneal edema
Dilated, un-reactive,
vertically oval pupil

40. Pupil block glaucoma
Ch. Congestive glaucoma
Angle …peripheral anterior Synechiae
Symptoms and signs
Dec. severity

41. Pupil block glaucoma
Absolute glaucoma

42. Management
Stage I (prodromal attacks)
Surgical

Iridotomy (laser)

Iridectomy

43. laser iridotomy

44. Management prodromal attack
Medical
PILOCARPINE eyedrops

45. Mangement
 Stage of constant Instability
Same as prodromal attack

46. Managemant
Acute congestive stage
(a) Early

Control of I.O.P by medical means

Then perform iridectomy/iridotomy
(b) similar to stage 4

47. Management
Acute congestive glaucoma
Medical control of I.O.P
1. pilocarpine
constrict pupil
mid-dilated position changes
Force of contact b/w iris tights
Pupil and lens decrease
pupil block finished
control of I.O.P

48. Management
Acute congestive glaucoma
2)Carbonic anhydrase inhibitors
(acetazolamide)
CO2 + H2O H2CO3


H + HCO3
Inhibition HCO3 ions Aq.production

49. Management
Acute congestive glaucoma
3) Osmotic Agents
I.S Intravascular H2O I.S
Osmotic pressure Hydrostatic pressure Osmotic pressure
I.S pressure osmotic Pressure I.S pressure

50. Management
Acute congestive glaucoma
Agents
Oral

Pure glycerine

Alcohol
Intravenous
Mannitol 20%

urea

51. Management
Ch. Congestive glaucoma
Control of I.O.P by medical means
Perform filtration operations