Anatomy and Pa Tho Physiology of Aqueous Production and Outflow
Chapter 7 · Chapter 7 . Skills 54-59 . Slides edited by ... Episcleral veins . TS 54 : Aqueous...
Transcript of Chapter 7 · Chapter 7 . Skills 54-59 . Slides edited by ... Episcleral veins . TS 54 : Aqueous...
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Glaucoma
Chapter 7
Skills 54-59
Slides edited by Argyrios Tzamalis, MD, PhD, MA, FEBO
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TS 54 : Aqueous humor production & outflow
Ciliary body
Posterior chamber
Pupillary margin-lens
Anterior chamber
Trabecular meshwork
Schlemm’s canal
Episcleral veins
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TS 54 : Aqueous humor production & outflow
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TS 54 : Aqueous humor production & outflow
Obstruction of normal AH flow
Rise in IOP (acute or chronic)
Ganglion cells and optic fibres damage (GLAUCOMA)
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TS 55 : Pathophysiology of glaucoma
Asymptomatic in early stages
Creates negative, non-central scotomas (patient unaware of the condition)
Optic disk cupping= indicator of optic nerve atrophy
Chronic rise in IOP is the most common and well-studied risk factor for glaucoma
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TS 55 : Chronic glaucoma defects
• Scotomata • Arcuate scotomas
• Bjerrum’s scotomas
• Nasal step (Roenne’s step)
• Total, central-sparing defect (very advanced glaucoma)
• Contrast sensitivity
• Light adaptation
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TS 55 : High IOP and Glaucoma
• Raised IOP is not the cause but rather the main risk factor for Glaucoma
• Chronic Glaucoma is a multifactorial neuropathy
Evidence
• Normal Tension Glaucoma & raised IOP without glaucoma (ocular hypertension) are well known clinical entities
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TS 56 : Acute angle closure glaucoma
Deep ocular pain
Nausea-vomit
Reduced VA
Coloured halos around light sources
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TS 56 : Acute angle closure glaucoma
Conjunctival injection
Mid-dilated, non-reactive pupil
Shallow anterior chamber
Corneal opacification
Raised IOP
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TS 56 : Acute angle closure glaucoma
Admission to hospital
a) Drops Dexamethasone (anti-inflammatory)
b) Topical and systematic agents for reducing production of Aqueous (Dorzolamide, per os Acetazolamide 250 mg, Mannitol i.v)
c) Myotic agents (Pilocarpine 2% every 10’)
• After corneal transparency is achieved the patient
must receive a ΥΑG iridotomy
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TS 57 : Early glaucoma screening
IOP measurement
Automated Perimetry scotomas
Fundoscopy Disk cupping
OCT,HRT Optic fibres thinning
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TS 58 : Congenital glaucoma
• Optic neuropathy accompanied with raised IOP
• Globe is extensible in newborns and infants
• Therefore, raised IOP causes abnormally big eyes (buphthalmos)
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TS 59 : Secondary glaucoma - Causes
I. Uveitic glaucoma
II. Phaco-antigenic (proteins of mature lens)
III. Exfoliating glaucoma (exfoliating material)
IV. Pigmentary glaucoma (pigment dispersion)
V. Steroid-related glaucoma (usually drops)
VI. Neovascular glaucoma (Diabetic retinopathy, Central retinal vein occlusion)
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Electronic Referrals – 7th Chapter
1. http://cdn.intechopen.com/pdfs-wm/23814.pdf
2. http://www.glaucoma-association.com/what-is-glaucoma/flow-of-aqueous-humour.html
3. http://emedicine.medscape.com/article/1206147-overview
4. http://emedicine.medscape.com/article/798811-overview
5. http://www.eyecareamerica.org/eyecare/conditions/glaucoma/simulator.cfm
6. http://www.eugs.org/eng/EGS_guidelines.asp
7. http://gonioscopy.org/
8. http://www.researchgate.net/publication/7470938_Five_rules_to_evaluate_the_optic_disc_and_retinal_nerve_fiber_layer_for_glaucoma/file/9fcfd511041e90912d.pdf
9. http://www.worldglaucoma.org/AfricaSummit/Download/Budenz_Visual_Field_Basics.pdf
10. http://emedicine.medscape.com/article/1206081-overview