1. Glaucoma Abdulrahman Al-Amri, MD

2. Glaucoma  Definition & Epidemiology  Anatomy & physiology  POAG  ACG  Secondary glaucoma  Management  Quiz

3.  leading cause of blindness worldwide

4. GLAUCOMA IOP Cupping Visual Field Loss IOP Cupping Visual Field Loss

5. Anatomy and physiology Aqueous Humour  Secreted by the CB  Carbonic anhydrase enzyme is required  Aqueous outflow : TMW Uveoscleral TMW Uveoscleral Schlemm’s canal Schlemm’s canal Venous circulation Venous circulation

6. A/C angle structures  Schwalbe’s line  TMW: fenistrated sheet sheet  SS  CB

7. Anatomy of NFL

8. Tonometry Tonometry  Contact tonometry -Applanation tonometry -Applanation tonometry  Non-contact tonometry (NCT) -Air puff -Air puff

9. Gonioscopy examining AC angle

10. Perimetry Visual field testing

11. Classification of glaucomas  Cong vs acquired  Open vs closed  Primary vs secondary

12. Congenital glaucoma  Trabeculodysgenesis  Usually Sporadic Symp.  Photophobia  Tearing  Blepharospasm

13. Signs  High IOP  Buphthalmos  Large cornea  Corneal edema+/-  Cupping (Normal C:D ratio =0.3)

14. Treatment Surgica l

15. Acute Angle Closure Glaucoma Acute elevation of IOP Acute elevation of IOP Angle closure by: Angle closure by: -Pupillary block -Iris crowding Predisposing factors

16. Symptoms  Sudden ocular pain   Rapid loss of vision*   Tearing   Photophobia   Headache   Nausea   Vomiting

17. Signs  Ciliary congestion  Mid dilated pupil (due to pressure on ciliary nerves and vessles)  High IOP  Corneal edema  Closed angle

18. Surgical YAG laser iridotomy

19. Treatment of Acute Angle-Closure Glaucoma Hyperosmotic agents Intravenous mannitol B- Topical therapy Pilocarpine Beta-blockers 1.Medical A-Systemic CAI Acetazolamide 2.Surgical YAG laser iridotomy

20. Primary Open Angle Glaucoma- POAG  Above 40yr usually  Bilateral  Asymptomatic in early stages

21. Risk Factors  Age  FH  Steroids  Myopia  DM

22. Primary Open angle Glaucoma POAG Mechanical Ischemic

23. IOP > 21 mmHg Cupping Open angle Visual field loss Primary Open Angle Glaucoma-POAG

24. Progression

26. Pseudoexfoliation  Firillar material, similar to amyloid  Deposition in the TMW….high IOP

27. Phacomorphic glaucoma

28. Glaucoma Drugs  Drugs to decrease the production of aqueous humor.  Drugs to increase the outflow of aqueous humor. –Trabecular channels –Uveoscleral channels

29. Management  Medical -Topical-Systemic  Surgical -Trabeculectomy -Tube-shunt surgery -Cyclodestructive procedures

30. Medical Topical Production  Sympathomimetics (adrenergic agonists)  Beta blockers Outflow  Parasympathomimetics (Miotics-cholinergic ag)  Prostaglandin analogues

31. –Allergic conjunctivitis –Punctate keratitis –Bradycardia –Bronchospasm –Hypotension – libido –Depression Glaucoma Drugs – Side Effects Betablockers

32. Generics –Brimonidine Tartrate (0.2% solution) Glaucoma Drugs Adrenergic Drugs

33. –Lid edema –Conjunctivitis –Fatigue –Drowsiness –Apnea –bradycardia –hypotension Glaucoma Drugs – Side Effects Adrenergic Drugs

34.  Generics –Acetazolamide (250 mg tabs, 500mg caps, (250 mg tabs, 500mg caps, 500 mg IV solution) 500 mg IV solution)  Brands –Diamox Glaucoma Drugs Carbonic Anhydrase Inhibitors (CAI’s)

35. Ocular: –Allerg conjunctivitis Systemic: *Tingling sensation of hands & feet *Steven-johnson sx *Renl stone *GIT –Headache / fatigue –Dry mouth –Dec. libido, –Depression Glaucoma Drugs – Side Effects Carbonic Anhydrase Inhibitors (CAI’s)

36.  Action: –Reduce IOP by increasing the outflow through uveoscleral channels –Lowers IOP in 3- 4 hrs after instillation  Generics –Latanaprost (0.005% Sol.) (0.005% Sol.)  Brands –Xalatan Glaucoma Drugs Prostaglandin Analogs

37. Heterochromia

38. MIOTICS (2% Sol.) –Produce miosis (small pupil) Generics –Pilocarpine Hydrochloride Glaucoma Drugs Drugs to Increase the Outflow

39. Medical Systemic   Hyperosmotic agents   Carbonic anhydrase inhibitors

40.  Generally used in emergency situation when rapid decrease of IOP is needed for AACG.  Action: – increased S. osmolarity : drawing fluid out of the vit across vascular barriers. drawing fluid out of the vit across vascular barriers. Glaucoma Drugs Osmotic Agents

41. Management  Surgical -Trabeculectomy -Tube-shunt surgery -Cyclodestructive procedures