Pathogenesis of glaucomatous damage

Block of neurotrophin to retinal ganglion cell (RCG) cause RCG death. This will result in death of nerve fiber (axon) in characteristic pattern.

Factor involve in RCG death:

Primary insult
1. Raised intraocular pressure
Cause stretching of lamina cribirosa lead to alteration in capillary blood flow lead to iscahemia and death of nerve axon.
2. Pressure independent factor - theory in NTG but also affect in pt with raised IOP.
- failure of autoregulatory mechanism of blood flow
- vasospasm such as in migranous headache and Raynaud phenomenon
- systemic hypotension esp in pt who have nocturnal dips
- acute blood loss that cause reduce in supply

Secondary insult ( excitotoxicity theory)
- RCG death will release glutamate (excitotoxin), oxygen free radicals or nitric oxide that will lead to cell mediated apoptosis. This will cause continuous cell death ven after primary insult controlled.


- Posted using BlogPress from my iPad