GLAUCOMA PREVENTION: Types,Risk Factors,Sign & Symptom,Surgery and Tricks

GLAUCOMA

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)

(B) Secondary Glaucoma
(C) Congenital Glaucoma

4. PATHOPHYSIOLOGY

5. SIGN&SYMPTOM
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

(ii)Trabeculectomy

(iii)Laser Iridectomy

(iv)Cryotherapy
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

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

(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

(Laser iridectomy surgery done in Primary angle closer Glaucoma)

2. Secondary Glaucoma

(i) Diabetes mellitus (DM)
(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

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

Example:-

1.α-Adrenergic:- 
               (a) APRACLONIDINE
               (b) BRIMONIDINE

2.β-Adrenergic:-
 [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

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 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.

 >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.

MNEMONIC:-

Red Eye Mnemonic

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