Glaucoma - Bahan Kuliah 12 Des 2014

7/21/2019 Glaucoma - Bahan Kuliah 12 Des 2014

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Dr. NENI K. PARIMO, Sp.M

G L A U C O M

A


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GLAUCOMA

A damage of optic nerve head (Papil N.Opticus)

characterized by:

- !cavation of optic nerve papil

- Narro"ing of visual field

Primarily caused by increase of intra ocular pressure

Intra Ocular Pressure (IOP)

#igh $OP

% && mm#g

Definition


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IOP examination:

'igital

chiotz indentation tonometer

Applanation tonometer

- ontact

- Non-contact

Digital

- stimation- omparing right and left eye

- *echni+ue

pressing the eyeball "ith t"o pointing


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Schiot !onometer

points on scale

conversion to mm#g

A""lanation !onometer

indicates mm#g


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IOP #xamination $ith Schiot tonometer:

,ive inform consient to the patient

Patient lies in bed

Apply topical Pantocaine ./ on eye

*onometry "ith .g "eight is tested on the steel plate

points at zero

*onometry is put over cornea

0ead the scale convert by provided table to mm#g

$f the reading is 1 23 the "eight is added (replaced) by

4.g or 5g


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O"tic %er&e Pa"il

- Normal 6' 0atio .& 7 .2- !cavation % .8


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'isual iel #xamination :

onfrontation *est

*angent creen

,oldman Perimetry

omputerized - Octopus

- #umphrey


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Glaucoma Classification

A* Primar+ Glaucoma

5. Open angle 6 simple chronic glaucoma

&. hronic closed angle glaucoma 6 chronic congestive

glaucoma

2. Acute closed angle glaucoma 6 acute congestive glaucoma

According to gonioscopy


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,* Seconar+ Glaucoma

5. 9ens 'islocation &.

ataract2. veitis

;. #yphema

. orticosteroid

8. 0ubeosis iridis

D* A-solute Glaucoma No vision 6 9P 7

C* Congenital Glaucoma


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A* Primar+ Glaucoma

D+namics of .umor A/ueous :

Production cilliary body nonepithelium

Posterior chamber pupil anterior chamber

onventional *rabeculair


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O"en angle glaucoma0 chronic sim"le glaucoma

- chronic

- progressive

- bilateral

Signs :

- $OP % && mm#g- open angle

- visual field narro"ing

- enlargement of 6' 0atio

S+m"toms :

- "hite eye "ith blurred vision

- fre+uent bumpingon movement 6 "al=ing - tunnel vision


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0estriction of the isual Bield


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Patho"h+siolog+

- 'egeneration of trabecula3 chlemm>s canal- ,enetic aspect


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*reatmentA.


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C. 9aser *rabeculoplasty

- $f medication fails

. urgery

- $f medication and 9aser trabeculoplasty

fails

-


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Path"ay of a+ueus egress follo"ing trabeculectomy


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- Ocular h+"ertension

- Lo$ !ension Glaucoma

$ntra ocular pressure "ithin normal limits

igns of glaucoma present

'amage of the optic nerve e!cavation

isual field defect

#igh $OP % &&mm#g

No sign of glaucomatous optic nerve damage


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Acute Primar+ Angle Closure Glaucoma ( Acute PACG)

Patho"h+siolog+

-Pupillary bloc=

- No pupillary bloc= 6 cilliary bloc=


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Pu"illar+ -loc2

5. Predisposing factors:- Narro" angle

- hallo" anterior

chamber - hort eye 6 a!ial length

- mall

corneal diameter

- Age

&. *riggering factors

-


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S+m"toms :

- ye pain

- 'izziness3 nausea3 vomiting- #alo 6 seeing rainbo"s blurred vision

Signs:

- $OP % && mm#g- P$ ? $- orneal edema bullous =eratopathy-

hallo" anterior chamber- Blare- Atrophy of the iris-


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PAI%UL 3#D #4# 5I!. 'ISUAL LOSS

3##3 IMM#DIA!#L4


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Definiti&e treatment :

- $ridectomy 6 laser iridotomy

- *rabecule=tomy

-


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Meical !hera"+ :

- ,lyserin p.o. 5ml6FgCG in / solution (mi!ed

"ith "ater)

- Acetazolamide3 initial dose mg ; ! & mg

- *imolol ./

& ! 5 drop

- Pilocarpin &/ ; 7 8 ! 5 drop

- *reat pain analgesics

-


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Chronic Close angle Glaucoma (Chronic PACG)

Patho"h+siolog+

- $ntermittent pupillary bloc=- No pupillary bloc= 6 cilliary bloc= intermittently


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Signs 6 S+m"toms

ame as Acute PA, but less severe

!reatment

ame as Acute PA,


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,* Seconar+ Glaucoma

5. 9ens 'islocation

&. ataract there are & pathogenesis :

5. Phacomorphic

- intumescent

cataract

pupillary bloc= closed angle glaucoma

&. Phacolytic

- #yper

mature cataract


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2. #yphema

blood particletrabecular mesh"or= obstruction

open angle glaucoma

;. veitis there are & pathogenesis :

5. Pupillary seclusion iris bombe PA closed

angle glaucoma

&. $nfllamatory cells inflamasi trabecular mesh"or=

obstruction open angle glaucoma


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. orticosteroid use

- *rabecular mesh"or= damage

8. 0ubeosis iridis

- Bormation of fibrovascular tissue atanterior chamber angle


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C* Congenital Glaucoma

S+m"toms :

9ight irritability

ran=y

*earing

yeball enlargement

Signs :

#igh $OP

piphora

Clepharospasm

Photophobia

Cuftalmos


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O' Culpthalmos. O Culpthalmos


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!reatment:

,oneotomy surgery

*rabeculotomy surgery

*rabeculectomy surgery


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D* A-solute Glaucoma

$s the end stage of all =inds of glaucoma3 "here the

vision is zero 6 9ight Perception ( - )


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Glaucoma - Bahan Kuliah 12 Des 2014

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