Download Precipitating factors for ACG

M.R Shoja MD
Shahid Sadoughi
Medical Science
Yazd. Iran
ACUTE GLAUCOMA
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ANATOMY OF EYE
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GLAUCOMA
Glaucoma is the second leading cause of
blindness in the world. In 2000 there
were an estimated 66.8 million people
with glaucoma , 6.7 million of whom had
bilateral blindness secondary to
glaucoma. Glaucoma has been definded
as a progresssive optic neuropathy
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Glaucoma classification
Closed angle :
- Primary
secondary
Open angle :
- Primary
- Secondary
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Acute angle closure
glaucoma
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Rapid increase in pressure of eye
In Asia is more common
2-3 times more common in
women than men
Much higher in hyperopic eyes
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Primary Angle Closure
Glaucoma (PACG)
Epidemiology:
1- Age
2-Gender
Eastern Asia
3-Race
less in black
4-Heriditary
5-Refractive Error
6-Seasonal Incidence
(10% of all glaucoma , 5-10% bilatesal)
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Precipitating factors
1-Mydriasis
Darkness
Medications
Emotional upset
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2- Extreme Miosis
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3- Prone position
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Dramatic symptoms
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Severe eye pain
nausea and vomiting
Headache
Blurred vision
Haloes around light
Profuse tearing
Fix mid-dilated pupil
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Findings
Diminished vision
Ciliary flush , corneal Edema
Elevated Iop (40-75 mmHg )
Shallow Anterior Chamber
Dilated , vertically Oval nonreactive pupil.
Cell and Flare in Ac
Hyperemic Swollen optic disk
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Exams &
Tests
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Gonioscopy
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Tonometry
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Biomicroscopy
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Ophthalmoscopy
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Perimetry
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Treatment
B-adrenergic antagonist
Timolol
-adrenergic agonist :
Apraclonidine
Acetazolamid
Trusopt
Hyper osmotic agent
Laser iriditomy
PI
Surgical iridectomy
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Acute Angle Closure Glaucoma
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Hx: severe ocular pain with nausea and
vomiting
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Pupil mid-dilated and oval
Blurred vision
Coloured haloes around lights due to corneal
oedema
Rx: emergency referral to ophthalmologist
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Miotics (Pilocarpine), beta-blockers (Timoptic)
Aqueous suppressors (Acetazolamide)
Hyperosmotic agents (glycerol, Mannitol)
Once attack is broken, laser iridotomy indicated
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Congenital glaucoma
1.
2.
Primary
Secondary
(Sturg-weber )
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Primary congenital
(Infantile glaucoma)
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60% are diagnosed by 6 months
80% within first year
65% are male
Bilateral in 70% cases
Incidence being 1 in 25000 births
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Eye exam
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Buphthalmos
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Corneal enlargement > 13mm
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Corneal edema
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Glaucomatous cupping
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Symptoms
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Epiphora
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Photophobia
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Blepharospasm
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Differential diagnosis
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Birth trauma
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Obstruction of lacrimal system
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Congenital syphilis, rubella
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Mucopolysaccahridoses
CHED
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GLAUCOMA
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Treatment
Surgical
1.
Goniotomy
2.
Trabeculotomy
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