glaucoma for 5th class university of kufa college of medicine by dr.zaid shukur

1. GLAUCOMA
By
Zaid Yousif Shukur
M.B.Ch.B., M.Sc., I.C.O., D.O.
Assistant professor
University of Kufa, college of medicine
Zaid.shukur@uokufa.edu.iq

2. The eye as a sphere need to be maintained in
its shape that is filled by aqueous humour
anteriorly and vitreous gel posteriorly, the
aqueous humor is the fluid filling the anterior
segment of the eye which is anterior to the
crystalline lens. while the vitreous gel is
gelatinous material filling the eye behind the
crystalline lens ,

3. aqueous humour is produced constantly behind
the iris by the nonpigmented cilliary epithelium
flows through the pupil into the anterior chamber
and is drained out of the eye through this drainage
angle. This fluid circulation maintains the normal
pressure within the eye, what we call it the
intraocular pressure(IOP)

4. Glaucoma is a group of diseases of the eye
characterized by progressive pathological
changes in the optic nerve and typical visual
field defects, with or without increased
intraocular pressure
DEFINITION

6. in other word glaucomas are a group of optic
progressive degeneration of retinal ganglion cells.
These are central nervous system neurons that
have their cell bodies in the inner retina and axons
in the optic nerve.

8. Degeneration of these nerves results in cupping,
a characteristic appearance of the optic disc, and
visual loss. The biological basis of glaucoma is
poorly understood and the factors contributing to its
progression have not been fully characterized.

12. Glaucoma affects more than 70 million people
worldwide with approximately 10% being bilaterally
blind, making it the leading cause of irreversible
blindness in the world.

13. Sielence property
Who can Work in the dark to steal
light?

14. Glaucoma can remain asymptomatic until it
is severe, resulting in a high likelihood that the
number of affected individuals is much higher
than the number known to have it. Population-
level surveys suggest that only 10% to 50% of
people with glaucoma are aware they have it.

15. Glaucomas can be classified into 2 broad
categories: open-angle glaucoma and angle-
closure glaucoma. In the United States, more than
80% of cases are open-angle glaucoma; however,
angle-closure glaucoma is responsible for a
disproportionate number of patients with severe
vision loss.

16. Both open-angle and angle-closure
glaucoma can be primary diseases. Secondary
glaucoma can result from trauma, certain
medications such as corticosteroids, inflammation,
tumor, or conditions such as pigment dispersion or
pseudo-exfoliation.

17. ‘anterior chamber angle; refers to the drainage
angle which is located at the junction of the edge
of the peripheral cornea and the iris root
(periphery)

18. In open angle glaucoma the fluid has full access
to the AC angle, the rise in IOP occurs more
slowly and the patient is often unaware of the IOP
rise.

19. In angle closure glaucoma access of fluid to AC
angle is physically blocked resulting in sudden, and
often painful, rise of iop with photophobia acute
ocular pain , nausea vomiting, in SLE: diffuse
corneal epith edema, shallow ac , fixed mid-dilated
non reaction pupil, high iop, ……requiring
emergency treatment.

20. Angle-closure glaucoma represents the second
most common type of glaucoma, but its impact is
more critical due to a greater likelihood of
blindness than in patients with open angle
glaucoma. A timely and accurate diagnosis is
essential in order to start the appropriate and
specific treatment that may prevent progression to
greater and irreversible damage.

21. Angle closure entities can be classified into
primary and secondary forms. Primary angle-
closure glaucoma occurs in an anatomically and
functionally predisposed eye, not as a
consequence of other ocular or systemic
abnormalities.

22. Secondary forms of angle-closure glaucoma
are caused by other ocular or systemic
abnormalities (uveitis, neovascular glaucoma,
Marfan´s Syndrome), medications, such as
topiramate (for epilepsy, and migraine
treatment)

28. Treatment of Glaucoma

29. Benefit of IOP Reduction
Elevated IOP has been established as the main
risk factor for disease evolution in glaucoma, and
there is strong evidence that strict IOP control can
delay progression of the disease.

30. Its estimated that each 1-mm-Hg decrease in IOP
was associated with a roughly 10% reduction in
the risk of visual field or optic disc progression

31. Primary care physicians can play an important
role in the diagnosis of glaucoma by referring
patients with positive family history or with
suspicious optic nerve head findings for complete
ophthalmologic examination.

32. They can improve treatment outcomes by
reinforcing the importance of adherence to
medication and by recognizing adverse
reactions from glaucoma medications and
surgeries.

33. Once the decision begins; medical treatment is
made, the goal is clear:
to reduce progression risk by preventing, or at least
slowing, glaucomatous damage to the optic nerve.
To this day, lowering intraocular pressure (IOP) has
been the only means to accomplish this goal,
regardless of the stage of the disease.

34. Eye drops used in managing glaucoma decrease eye
pressure by either decreasing the aqueous humor
secretion or increasing the trabecular aqueous escape or
widening the angle of the ac and other forms increase the
uveoscleral aqueous escape. Medications to treat
glaucoma are classified by their active ingredient.

35. A number of medications are currently in use to treat glaucoma.
Some medications are prescribed as single eye drop, or as
combination of two or three combinations or change the
prescription over time to reduce side effects or provide a more
effective treatment. Typically medications are intended to
reduce elevated intraocular pressure and prevent damage to
the optic nerve.

36. CLASSIFICATION
Systemic anti glaucoma medications, acetazolamide
Topical medications
The systemic medications include
Glyserin, urea, mannitol
Topical medications

37. Alpha Agonist , Iopidine® Apraclonidine HCI 0.5%, 1%
Alphagan® P Brimonidine tartrate 0.1%, 0.15%
Beta Blockers
Carbonic Anhydrase Inhibitors
Cholinergic (Miotic)
Prostaglandin Analogs
Rho Kinase Inhibitors
Combined Medications`

40. Non pharmaceutical treatment of glaucoma
include
laser therapies and surgery involving blebs,
stents, and/or filtering devices, are typically
withheld as options to fall back on when initial
medical therapy fails. Untreated glaucoma can
cause progressive visual loss potentially leading to
severe visual disability.

41. Thank you