GLAUCOMA
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| Glaucoma Eye |
In This Post
1.DEFINITION
2.RISK FACTOR
3.TYPES OF GLAUCOMA
(A) PRIMARY ADULT ANGLE GLAUCOMA
(i) Primary Open Angle Glaucoma(POAG)
(ii) Primary Angle Closer Glaucoma (PACG)
4. PATHOPHYSIOLOGY
(i)Opthalmoscopy
(ii)Perimetry
(iii)Tonometry
(iv)Gonioscopy
7. MANAGEMENT
9. MNEMONIC
DEFINITION
RISK FACTOR
(i) Family History
(i) Diabetes mellitus (DM)
(ii)Injury
(iii)Cataract
(iv)Tumor in Ciliary Process
(v)Corticosteroid uses
(i)Diabetes mellitus Mother
>Halos vision (white line a Colour Layer is Seen)
>Blurred Vision (Due to Retinal compression)
>Corneal erythema
>Pain with Nausea vomiting
MANAGEMENT
MEDICAL MANAGEMENT
A. Miotics
Example:-
3.Prostaglandin:-
4. Carbonic anhydrase inhibitor:-
Use in CONGENITAL GLAUCOMA
Reconstruction of the TRABECULE MESHWORK and open the canal
(B) Secondary Glaucoma
(C) Congenital Glaucoma
(C) Congenital Glaucoma
4. PATHOPHYSIOLOGY
5. SIGN&SYMPTOM
6. DIAGNOSIS
6. DIAGNOSIS
(i)Opthalmoscopy
(ii)Perimetry
(iii)Tonometry
(iv)Gonioscopy
7. MANAGEMENT
(a) Medical management
(i) Miotics
(ii) Sympathomimetic
(iii)Prostaglandin
(iv)Carbonic Anhydrase Inhibitor
(v) Osmotic Agents
(b)Surgical Intervantion
(i) Trabeculoplasty
(b)Surgical Intervantion
(i) Trabeculoplasty
(ii)Trabeculectomy
(iii)Laser Iridectomy
(iv)Cryotherapy
8. HEALTH EDUCATION
8. HEALTH EDUCATION
9. MNEMONIC
DEFINITION
Glaucoma is characterized by Increase INTRAOCULAR PRESSURE resulting atrophy of OPTIC NERVE leads to IRREVERSIBLE BLINDNESS.
The Increase INTRACCULAR PRESSURE Most common cause and only modifiable cause.
If Increase INTRAOCULAR PRESSURE but not damage of Optic nerve this condition known as INTRAOCULAR HYPERTENSION.
》NORMAL IOP LEVEL= 10-21mmhg
RISK FACTOR
(i) Family History
(ii)Diabetes mellitus (DM)
(iii)Corticosteroids Drugs
(iv)Cardio Vascular Disease
(iii)Corticosteroids Drugs
(iv)Cardio Vascular Disease
TYPES OF GLAUCOMA
1. Primary adult angle Glaucoma
Occur when Increase INTRAOCULAR PRESSURE inside the eyes and damage optic nerve and cause IRREVERSIBLE BLINDNESS.
(a) Primary Open Angle Glaucoma(POAG)
It is Most common type of Glaucoma
Increase INTRAOCULAR PRESSURE resulting Peripheral Retinal Damage and Anterior Angle is Maintained.
(i) Obstruction to Outflow of Aqueous humor
(ii) Painless
(iii)Peripheral Vision Loss
(iv)Tunnel Vision
(v)"Theft of Sigh"
(vi)Community Associated Glaucoma
(ii) Painless
(iii)Peripheral Vision Loss
(iv)Tunnel Vision
(v)"Theft of Sigh"
(vi)Community Associated Glaucoma
(b) Primary angle Closer Glaucom (PACG)
(i) Blocking the Outflow of Aqueous humor into the Trabecular meshwork
(ii) Medical Emergency
(iii)Halos arrount the Light
(iv)Ocular erythema
(v)Painful
(vi)PACG occure in DIM LIGHT
(ii) Medical Emergency
(iii)Halos arrount the Light
(iv)Ocular erythema
(v)Painful
(vi)PACG occure in DIM LIGHT
(Laser iridectomy surgery done in Primary angle closer Glaucoma)
2. Secondary Glaucoma
(ii)Injury
(iii)Cataract
(iv)Tumor in Ciliary Process
(v)Corticosteroid uses
3. Congenital Glaucoma
(i)Diabetes mellitus Mother
(ii)Infection (TORCH)
(iii)Tumor in Trabecular meshwork
(iv)Structural abnormality in Trabecular meshwork
(iii)Tumor in Trabecular meshwork
(iv)Structural abnormality in Trabecular meshwork
PATHOPHYSIOLOGY
Due to etiology
↓
Increase Aqueous Humor
OR
Decrease Aqueous Humor absorption
↓
Increase Intra Occular Pressure
↓
Damage the optic nerve of Retina
↓
GLAUCOMA
SIGN & SYMPTOM
>Halos vision (white line a Colour Layer is Seen)
>Blurred Vision (Due to Retinal compression)
>Corneal erythema
>Pain with Nausea vomiting
DIAGNOSIS
OPTHALMOSCOPY
↓
Increase Cupping of Optic Disk
PERIMETRY
↓
Decrease peripheral vision
TONOMETRY
↓
Assess INTRAOCULAR PRESSURE
GONIOSCOPY
↓
Measure the angle of Anterior Chamber (45°Normal)
MANAGEMENT
MEDICAL MANAGEMENT
A. Miotics
Mode of Action
They decrease INTRAOCULAR PRESSURE by opening the angle of Anterior Chamber
Example:- 1. Pilocarpine
2. Ecothiophate
Constricts Pupil+Contracting the ciliary muscle
↓
Increase Blood Flow to Retina
↓
Decrease Retinal damage
B. Sympathomimetic
Decrease INTRAOCULAR PRESSURE by Sympathetic Impulse and Decrease Aqueous humor without affect of accommodation or Pupil size
1.α-Adrenergic:-
(a) APRACLONIDINE
(b) BRIMONIDINE
(a) APRACLONIDINE
(b) BRIMONIDINE
2.β-Adrenergic:-
[Increase outflow of Aqueous humor]
[Increase outflow of Aqueous humor]
(a) TIMOLOL (DRUG OF CHOICE GLAUCOMA)
(b) BETAXOLOL (Increase blood glucose level and asses pulse before administer)
3.Prostaglandin:-
(a) Latanoprost
(b) Travoprost
(c) Bimatoprost
(b) Travoprost
(c) Bimatoprost
4. Carbonic anhydrase inhibitor:-
Mode of Action It decrease the Aqueous humor production result decrease INTRAOCULAR PRESSURE
(a) ACETAZOLAMIDE
(b) DORZOLAMIDE
(c) BRINZOLAMIDE
5.Osmotic Agents
1 Mannitol
Do not give ATROPINE SULPHATE in Glaucoma Patient Cause PUPIL DIALATE and increase Intraocular Pressure.
SURGICAL INTERVANTION
1. TRABECULOPLASTY
Use in CONGENITAL GLAUCOMA
Reconstruction of the TRABECULE MESHWORK and open the canal
↓
Increase absorption of Aqueous humour
2. TRABECULECTOMY
Resection of Trabecule meshwork
↓
Increase Aqueous humour outflow
↓
Decrease INTRAOCULO PRESSURE
3.LASER IRIDECTOMY
Resect the iris and open the angle of Anterior Chamber
↓
Increase Aqueous Humor
4. CRYOTHERAPY
Destroy the ciliary process
↓
Decrease Aqueous Humor
HEALTH EDUCATION
>Instruct the client to avoid all activities which cause increase Intraocular Pressure.
EXAMPLE:-
>Straining
>Weigh Lifting
>Constipation
>Instruct the client to avoid all activities which cause increase Intraocular Pressure.
EXAMPLE:-
>Straining
>Weigh Lifting
>Constipation
>Instruct the client to the Importance the medication.
>Instruct the client about the need for life long medication.
>Instruct the client to avoid Anticholinergic.
>Instruct the client to report eye pain,changes in the vision.
>Assess breath sounds for Wheezes and Ronchi because some medication can cause Bronchospasms and increase Bronchial seceration.
>Always have Atropine Sulfate available as an antidote for PILOCARPINE.
>Instruct clients with Diabetes Mellitus using Beta Blocker to moniter blood glucose level Frequently.
>Instruct the client to report the hospital if Shortness of Breathing occur after taking medication.
>Carbonic Anhydrase Inhibitors medication contra indication in the client allergic of Glaucoma.
>Carbonic Anhydrase Inhibitors Cause HYPOKALEMIA so assess the level of Potassium before and after taking medication.
>Instruct the client to report eye pain,changes in the vision.
>Assess breath sounds for Wheezes and Ronchi because some medication can cause Bronchospasms and increase Bronchial seceration.
>Always have Atropine Sulfate available as an antidote for PILOCARPINE.
>Instruct clients with Diabetes Mellitus using Beta Blocker to moniter blood glucose level Frequently.
>Instruct the client to report the hospital if Shortness of Breathing occur after taking medication.
>Carbonic Anhydrase Inhibitors medication contra indication in the client allergic of Glaucoma.
>Carbonic Anhydrase Inhibitors Cause HYPOKALEMIA so assess the level of Potassium before and after taking medication.
>Advise the client do not exposure to the sunlight for long time.
>Instruct the client to avoid Hazardous activities while vision is Impaired.
>Teach the Client not to wear contact lenses during or within 15 minutes of instilling these medication.
>Instruct the client to avoid Hazardous activities while vision is Impaired.
>Teach the Client not to wear contact lenses during or within 15 minutes of instilling these medication.
MNEMONIC:-
Red Eye Mnemonic
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