glaucoma

Glaucoma: leading cause of irreversible loss of vision

-cause b y increase IOP

Glaucoma is progressive optic neuropathy

Risk factor : IOP

Other risk factor:

-myopia

-DM, HPT,

-thin cornea

-increasing age

-family hx of glaucoma

Classification according to etiology / age type

one of classification:

congenital

acquired:

1. primary: divide to open angle and closed angle glaucoma

2 secondary

-open angle: trauma, sterois, pseudoexfoliation, pigment dispersion

-close angle: rubeosis sec to diabetes

low tension glaucoma

assessment of glaucoma:

-gonioscopy to look at the angle

-tonometer to look for IOP

-slitlamp examination for secondary cause

-computerised visual field examination

-change of optic disc or visual field over time

PRIMARY OPEN ANGLE GLAUCOMA

-most common (70%)

-symp: asymptomatic, visual field defect, blind

-sign: visual field defect/ blindness in advance case, increase IOP, open angle, glaucomatous cupping of disc

TREATMENT

1. Prostaglandin: first line: latanoprost,bimatoprost etc. side effect: red eye (transient), increase pogmentation of iris, iritis, eyelash growth

2. Beta blocker: second line or as adjuvant because of the SE

- respi: caution in asthma and coad

-cardiac: brady cardia/ heart block

-neuro: lethargy, mood changes, loss of libido, impotence

3.adrenergic agonist: alphagan/ lopidine

4.parasympathomimetic (pilocarpine): miosis (reduce night vision),cataract.iritis

5.carbonic anhydrase inhibitor: pilocarpine