1. Glaucoma
Group of diseases characterized by increased intraocular pressure resulting in damage to the optic nerve and retinal nerve fibers

2. It is a combination of ocular conditions that result in damage to the optic nerve head and a loss of the visual field. Most forms of glaucoma follow the classic triad of (1) increased intraocular pressure, (2) optic nerve damage, and (3) a loss of side vision.

3. It is a symptomatic condition of the eye in which the I. O. P
It is a symptomatic condition of the eye in which the I.O.P. exceeds the tolerance the affected eye resulting in visual dysfunction

4. Rise in intraocular pressure(IOP)
Determined by:
1.An increase in formation of the aqueous
2.A decrease in the drainage of the aqueous

5. Decreased drainage Plays: Improper development of the angle of A.C.
Narrow configuration of the angle of A.C.
Obstruction of the trabecular mesh work (particulate material)
Peripheral anterior synechiae
Plasmoid aqueous
Pupil block (lens/seclusio pupillae)

6. Classification of Glaucoma
A. Primary Glaucomas
B.Secondary Glaucomas

7. Primary Glaucomas 1.Primary congenital glaucomas
Early onset congenital glaucoma(Buphthalmos)
Late onset congenital glaucoma (Infantile)
Glaucoma associated with congenital anomalies

8. B.Secondary Glaucomas 2.Primary open angle glaucoma(POAG)
a. Primary open angle glaucoma (High pressure)
b.Primary open angle glaucoma (Low pressure or Normal pressure)
3.Primary angle closure glaucoma(POAG)
B.Secondary Glaucomas

9. Primary open glaucoma(POAG)
Previously known as Chronic simple glaucoma
Defined as
Chronic progressive neuropathy resulting
- (Cupping of the disc)
Visual field defects
Associated with elevated IOP

10. Pathophysiology Interference of outflow
May be due to degenerative changes in:
Trabecular
Schlemm’s canal
Exit channels

11. Fig. 3.11:  Aqueous humor (green) drains through the trabecular meshwork into Schlemm's canal.
Increase outflow resistant in trabecular meshwork or in Schlemm canal

12. POAG: Presentations More common than angle closure
Age 40yrs and > Much more common
Male more affected ?
Familial tendency More
Associated with diabetes 3 time more
Preferentially in subjects of Vascular sclerosis
Increased prevalence in High myopia

13. B/L symptom free chronic condition
Slow progressive course
Mild pain in eye/periorbital region
Frequent change of glass
Insidious onset (unnoticed till serious field impairment)
Slow and silent killer of the vision
(Known as Chronic Simple Glaucoma)

14. Suggestions Eye examinations: - Before Admission at primary school
- Thorough if possible twice in year
- If impossible Once in a year
Detail examination advised to begin Presbyopic glass
Screening camps in school or Target Population

15. Intra Ocular Pressure(IOP)
Great variation in open angle glaucoma
Careful tonometry is essential
Exaggeration of the normal diurnal variation
Mean of 3.7 mm of Hg
Biphasic rise in some patients may occur.
Asymmetric C.D.R.> 0.2
Nasal displacement of blood vessels

16. Cupping of the disc Physiological cupping Pathological cupping
Cup Disc Ratio

17. Visual field defect Must be determined - Central field
Peripheral field
1.Small Central/Para central Scotomas (2 to 4 degree)
Relative / Absolute

18. 2.Sickle extension of blind spot (above/below)
- Seidel’s Sign
- Bjerrum’s scotoma
-Roenne’s nasal step
- Tubular vision
small central/Para central visual field
(visual acuity may or may not be affected)
Generalized constriction of the peripheral field is considered as early glaucoma
Peripheral field may be generalized constriction

19. Primary Normal Tension/Low tension Glaucoma
Ocular Hypertension

20. Angles

21. Normal aqueous out flow

22. Abnormal aqueous out flow

25. Diagnosis of POAG
Early detection(funduscopy)
Observation/follow-up
Recording of IOP different methods
CDR evaluation
Photography of the disc
Visual field central/peripheral recording and Comparing

26. Normal or low tension glaucoma
Glaucoma is usually high pressure inside the eye that damages the optic nerve and can result in permanent vision loss.
Normal-tension glaucoma (also called low-tension glaucoma) is a unique condition in which optic nerve damage and vision loss have occurred despite a normal pressure inside the eye.

27. NTG/LTG
Normal tension glaucoma (NTG), also known as low tension or normal pressure glaucoma
is a form of glaucoma in which damage occurs to the optic nerve without eye pressure exceeding the normal range.
In general, a “normal” pressure range is between mm Hg.

28. Glaucoma is generally associated with high pressure in the eyes
But many cases of glaucoma occur in the absence of high pressure readings during exams.

29. Ocular hypertension
Ocular hypertension is an elevation of the pressure in the eye above the range considered normal with no detectable changes in vision or damage to the structures of the eyes.

30. Normal disc

31. Normal disc

32. Normal disc

36. Glaucomatous Cupping

37. Primary optic atrophy

44. Reduce IOP to the level:
Management of POAG
Reduce IOP to the level:
-Doesn’t cause damage to optic nerve/fibers of the nerve
-Judged by stabilizing visual field
-Unchanged appearance of optic disc
Visual field defect progressing after normalization of IOP
Indications:
Medical +Surgical
Combination

45. Management
Medical Treatment
Laser treatment
Surgical treatment

46. 1.Medical treatment Cholinergic Drugs(Parasympathomimetics effect
Pilocarpine
Carbachol
Binding cholinesterase
(Anticholinesterase action)
- Resulting constriction of pupil(miosis)
- Contraction of ciliary muscles
- Opening Trabecular meshwork
- Facilitates the aqueous outflow

47. Adrenergic Antagonist or Beta-Blockers
Nonselective Beta1 and Beta 2agents:
-Timolol maleate:
Reduces IOP lowering the rate of aqueous production
May result Broncho spasm and Vascular Hypotension
Selective Beta blocker (B1Blocker)

48. Carbonic anhydrase inhibitor
Acetazolamide
Reduces IOP by decreasing:
The carbonic anhydrase depend aqueous production
Decreases the availability of Bicarbonate
2. Laser Trabeculoplasty(LT)
-Argon laser or Diode laser Trabeculoplasty to control IOP
-Alternative of filtration surgery
3.Trabeculectomy
4.Trabeculotomy

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