GLAUCOMA

3. Definition of GlaucomaDefinition of Glaucoma
GlaucomaGlaucoma is a group of eye diseases that damage is a group of eye diseases that damage
the optic nerve. The optic nerve is the main the optic nerve. The optic nerve is the main
nerve to the eye (located in the back of the nerve to the eye (located in the back of the
eye) that is responsible for transmitting eye) that is responsible for transmitting
electrical impulses to the brain. Damage electrical impulses to the brain. Damage
usually occurs as a result of elevated pressure usually occurs as a result of elevated pressure
of the fluid (aqueous humor) in the eye. This of the fluid (aqueous humor) in the eye. This
damage results in gradual visual changes and damage results in gradual visual changes and
then loss of vision.then loss of vision.

4. TypesTypes
 Open-angle glaucomaOpen-angle glaucoma
 Closed angle glaucomaClosed angle glaucoma

5. Open-angle glaucomaOpen-angle glaucoma
(Also called primary open-angle glaucoma (Also called primary open-angle glaucoma
and chronic glaucoma) accounts for 90 percent and chronic glaucoma) accounts for 90 percent
of all glaucoma cases and occurs when the of all glaucoma cases and occurs when the
trabecular meshwork becomes blocked and the trabecular meshwork becomes blocked and the
fluid can't get to the normal drainage canals. fluid can't get to the normal drainage canals.
This blockage results in fluid build-up and This blockage results in fluid build-up and
intraocular pressure. The fluid build-up intraocular pressure. The fluid build-up
happens gradually.happens gradually.

7. Closed angle glaucomaClosed angle glaucoma
(Also called acute glaucoma or angle closure (Also called acute glaucoma or angle closure
glaucoma), accounts for about 9 percent of all glaucoma), accounts for about 9 percent of all
glaucoma cases and occurs when the opening glaucoma cases and occurs when the opening
between the cornea and iris narrows, such that between the cornea and iris narrows, such that
the fluid cannot get to the trabecular the fluid cannot get to the trabecular
meshwork and normal drainage channels. This meshwork and normal drainage channels. This
narrowing results in fluid build-up and narrowing results in fluid build-up and
intraocular pressure. The fluid build-up intraocular pressure. The fluid build-up
happens very quickly.happens very quickly.

8. Other less common glaucomasOther less common glaucomas
include:include:
 Normal tension glaucomaNormal tension glaucoma: optic nerve is damaged: optic nerve is damaged
even though intraocular pressure is consistentlyeven though intraocular pressure is consistently
within a normal rangewithin a normal range
 Congenital glaucomaCongenital glaucoma: incorrect or incomplete: incorrect or incomplete
development of the eye's drainage canals during thedevelopment of the eye's drainage canals during the
prenatal periodprenatal period
 Childhood glaucomaChildhood glaucoma: open-angle glaucoma in: open-angle glaucoma in
infancy, childhood or adolescenceinfancy, childhood or adolescence
 Secondary glaucomaSecondary glaucoma: occurs as a result of eye: occurs as a result of eye
injury, inflammation or tumor, or in advanced casesinjury, inflammation or tumor, or in advanced cases
ofof cataractscataracts oror diabetesdiabetes

9. Causes and Risk Factors of GlaucomaCauses and Risk Factors of Glaucoma
Several factors that can put a person "at risk" forSeveral factors that can put a person "at risk" for
developingdeveloping glaucomaglaucoma::
 Family history of glaucomaFamily history of glaucoma - There is a 20 percent- There is a 20 percent
chance of developing glaucoma of a parent had it, andchance of developing glaucoma of a parent had it, and
50 percent chance if a sibling has it.50 percent chance if a sibling has it.
 AgeAge - If the person is 65 to 79 years of age, there is a 3- If the person is 65 to 79 years of age, there is a 3
percent chance of developing glaucoma. If the person ispercent chance of developing glaucoma. If the person is
80 years of age or older, there is a 14 percent of80 years of age or older, there is a 14 percent of
developing glaucoma.developing glaucoma.
 Medical conditionsMedical conditions, such as morning, such as morning
headaches,headaches, diabetesdiabetes, lupus,, lupus, Crohn's diseaseCrohn's disease,,
rheumatoidrheumatoid arthritisarthritis, myopia (nearsightedness), and, myopia (nearsightedness), and
high blood pressurehigh blood pressure

10.  Use ofUse of topical steroidtopical steroid (prednisone or cortisone)(prednisone or cortisone)
medicationsmedications
 RaceRace - Blacks are three to four times more likely- Blacks are three to four times more likely
than Caucasians to develop glaucoma. Asians andthan Caucasians to develop glaucoma. Asians and
Eskimos are more likely to develop glaucoma thanEskimos are more likely to develop glaucoma than
Caucasians.Caucasians.
 AbnormallyAbnormally high intraocular pressurehigh intraocular pressure
 Previous eyePrevious eye injuriesinjuries
 Recurrent blurry visionRecurrent blurry vision
 PainPain around the eyes after watching TV or leavingaround the eyes after watching TV or leaving
a dark theatera dark theater

11. PathophysiologyPathophysiology
There are two accepted theories regarding how increased IOPThere are two accepted theories regarding how increased IOP
damages the optic nerve in glaucoma.damages the optic nerve in glaucoma.
The direct mechanical theoryThe direct mechanical theory
It suggests that high IOP damages the retinal layer asIt suggests that high IOP damages the retinal layer as
it passes through the optic nerve head.it passes through the optic nerve head.
The indirect ischemic theoryThe indirect ischemic theory
It suggests that high IOP compresses theIt suggests that high IOP compresses the
microcirculation in the optic nerve head, resulting in cell injurymicrocirculation in the optic nerve head, resulting in cell injury
and death. Some glaucomas appear as exclusively mechanical, andand death. Some glaucomas appear as exclusively mechanical, and
some are exclusively ischemic types. Typically, most cases are asome are exclusively ischemic types. Typically, most cases are a
combination of both.combination of both.

13. Symptoms of GlaucomaSymptoms of Glaucoma
Known as the "sneak thief" of sight,Known as the "sneak thief" of sight, open-angle open-angle glaucomaglaucoma has nohas no
early warning signs or symptoms. However, as the diseaseearly warning signs or symptoms. However, as the disease
progresses a person may experience:progresses a person may experience:
 Tiny blind spots appear at the edges of the visual fieldTiny blind spots appear at the edges of the visual field
(peripheral or side vision) that slowly get larger and spread(peripheral or side vision) that slowly get larger and spread
 Blurred visionBlurred vision
 Appearance of colored halos around lightsAppearance of colored halos around lights
 Adjustment problems on entering a dark roomAdjustment problems on entering a dark room
 Repeated difficulties that new eyeglass prescriptions do notRepeated difficulties that new eyeglass prescriptions do not
helphelp
 Peripheral (side) vision is decreasingPeripheral (side) vision is decreasing

14. The symptoms ofThe symptoms of closed angle glaucomaclosed angle glaucoma are:are:
 Severely blurred visionSeverely blurred vision
 Severe eye and head painSevere eye and head pain
 Nausea or vomitingNausea or vomiting
 Appearance of rainbow-colored halos aroundAppearance of rainbow-colored halos around
bright lightsbright lights
 Rapid loss of visionRapid loss of vision

15. DiagnosisDiagnosis
 There are four (4) important factors in theThere are four (4) important factors in the
diagnosis ofdiagnosis of glaucomaglaucoma: intraocular pressure,: intraocular pressure,
the condition of the optic nerve, the patient'sthe condition of the optic nerve, the patient's
visual field and the angle where the iris meetsvisual field and the angle where the iris meets
the cornea. To detect these factors, thethe cornea. To detect these factors, the
ophthalmologist will do the followingophthalmologist will do the following
diagnostic tests:diagnostic tests:

16. TonometryTonometry

17.  TonometryTonometry - used to measure intraocular pressure. Drops- used to measure intraocular pressure. Drops
are put in the eyes to numb the eye and then the doctorare put in the eyes to numb the eye and then the doctor
measures the eye pressure, using an instrument called ameasures the eye pressure, using an instrument called a
tonometer. This instrument measures the inner pressuretonometer. This instrument measures the inner pressure
of the eye by determining how much pressure isof the eye by determining how much pressure is
necessary to cause a slight indentation on the outer part ofnecessary to cause a slight indentation on the outer part of
the eye.the eye.
 OphthalmoscopyOphthalmoscopy - used to examine the inside of the eye,- used to examine the inside of the eye,
the optic nerve and the patient's field of vision. Drops arethe optic nerve and the patient's field of vision. Drops are
put in the eyes to dilate the pupil and then the doctor usesput in the eyes to dilate the pupil and then the doctor uses
an instrument called an ophthalmoscope that lights upan instrument called an ophthalmoscope that lights up
and magnifies the inside of the eye.and magnifies the inside of the eye.

19. If the intraocular pressures are not within normalIf the intraocular pressures are not within normal
range or if the optic nerve looks unusual, therange or if the optic nerve looks unusual, the
doctor may do a perimetry or a gonioscopy:doctor may do a perimetry or a gonioscopy:
 PerimetryPerimetry - a special test that produces a map- a special test that produces a map
of the complete field of vision.of the complete field of vision.
 GonioscopyGonioscopy - a test to check whether the angle- a test to check whether the angle
where the iris meets the cornea is open orwhere the iris meets the cornea is open or
closed.closed.

20. PerimetryPerimetry

21. GonioscopyGonioscopy

22. Treatment of GlaucomaTreatment of Glaucoma
 There is no cure forThere is no cure for glaucomaglaucoma, but it can be, but it can be
controlled. Ophthalmologists use medicationcontrolled. Ophthalmologists use medication
and surgery to prevent further vision loss.and surgery to prevent further vision loss.
These treatment methods are used to bring theThese treatment methods are used to bring the
intraocular pressure under control.intraocular pressure under control.

23. MedicationMedication
Nearly all glaucoma can be treated successfully with topical medicationsNearly all glaucoma can be treated successfully with topical medications
(applied directly to the eyes, such as eye drops or eye ointments) or(applied directly to the eyes, such as eye drops or eye ointments) or
oral medications (taken by mouth). There are six medicationsoral medications (taken by mouth). There are six medications
available to treat glaucoma:available to treat glaucoma:
 MioticsMiotics are eye drops that help open the drainage canals and increaseare eye drops that help open the drainage canals and increase
the flow of aqueous humor out of the eye. This type of medicationthe flow of aqueous humor out of the eye. This type of medication
includes pilocarpine (Isopto Carpine, Pilocar, Pilopine), carbachol andincludes pilocarpine (Isopto Carpine, Pilocar, Pilopine), carbachol and
echothiophate.echothiophate.
 Epinephrine compoundsEpinephrine compounds are eye drops that lower the intraocularare eye drops that lower the intraocular
pressure by increasing the rate of aqueous humor flow out of the eye.pressure by increasing the rate of aqueous humor flow out of the eye.
This type of medication includes dipivefrin (Propine) and Epifrin.This type of medication includes dipivefrin (Propine) and Epifrin.
 Beta-blockersBeta-blockers (available as eye drops or pills) help decrease the rate(available as eye drops or pills) help decrease the rate
at which the aqueous humor flows into the eye. This type ofat which the aqueous humor flows into the eye. This type of
medication includes topical timolol (Timoptic), levobunololmedication includes topical timolol (Timoptic), levobunolol
(Betagan), betaxolol (Betaoptic-S), Iopidine and Ocupress.(Betagan), betaxolol (Betaoptic-S), Iopidine and Ocupress.
Additionally, this type of medication can also be taken orally. OralAdditionally, this type of medication can also be taken orally. Oral

24.  Carbonic anhydrase inhibitorsCarbonic anhydrase inhibitors (available as pills or eye(available as pills or eye
drops) help reduce aqueous humor flow into the eye. Thisdrops) help reduce aqueous humor flow into the eye. This
type of medication includes oral acetazolamide (Diamox),type of medication includes oral acetazolamide (Diamox),
methazolamide (Neptazane) and chlorpropamidemethazolamide (Neptazane) and chlorpropamide
(Daranide), as well as topical dorzolamide (Trusopt).(Daranide), as well as topical dorzolamide (Trusopt).
 Alpha adrenergic agonistsAlpha adrenergic agonists are topical medications used toare topical medications used to
reduce the aqueous humor production and increasereduce the aqueous humor production and increase
aqueous humor outflow. This type of medication includesaqueous humor outflow. This type of medication includes
apraclonidine (Iopidine) and brimonidine (Alphagan).apraclonidine (Iopidine) and brimonidine (Alphagan).
 Prostaglandin analoguesProstaglandin analogues are topical medications that helpare topical medications that help
lower intraocular pressure by increasing uveosclerallower intraocular pressure by increasing uveoscleral
outflow (outflow through the soft tissues of the front of theoutflow (outflow through the soft tissues of the front of the
eye [iris and ciliary body]). This type of medicationeye [iris and ciliary body]). This type of medication
includes latanoprost (Xalatan).includes latanoprost (Xalatan).

25. Surgical managementSurgical management
 Argon laser trabeculoplasty (ALT)Argon laser trabeculoplasty (ALT)
 TrabeculectomyTrabeculectomy
 Laser peripheral iridotomyLaser peripheral iridotomy
 Surgical iridotomySurgical iridotomy