Download ophthalmohypertension

GLAUCOMA
AIM
glaucoma are among the heaviest diseases of
eyes, taking the third place in the world
among the reasons leading to irreversible
blindness. Necessity of studying of the theme
follows from the fact, that patients with this
pathology can address to any medical expert.
GOALS
The student should know:
• During analysis of patients with this pathology it is
necessary to pay students’ attention to the kind of an
injection (stagnant or pericorneal) and character of pain in
an eyeball at such urgent conditions, as a acute attack of
iridocyclitis and acute attack of close-angle glaucoma.
Differential diagnostics of these two conditions is very
important, since presence of pericorneal injection and local
pain testifies an inflammation of a vascular layer while the
stagnant injection and high ophthalmotonus is a typical
sign of close-angle glaucoma attack.
GOALS
• The student should be able:
– To find out the complaints and the short
anamnesis of disease;
– To check visual acuity of each eye;
– To examine peripheral borders of fields
of vision;
– Ophthalmoscopy: direct.
Glaucoma
• Glaucoma - is an eye
disease that can
characterize the state
of the anatomy of the
anterior chamber open or closed.
Therefore, there are
two types of
glaucoma: Openangle glaucoma
angle-closure
glaucoma
Glaucoma
•
Glaucoma is a triad:
•
Optic nerve damage
resulting from exposure
accompanied by elevated
intraocular pressure
Typical fields of vision
loss.
•
•
Types of Glaucoma
Overview anatomy of the eye
Types of Glaucoma
• What type of glaucoma is the most
common?
• 1) Open-angle glaucoma
• 2) Secondary glaucoma
• 3) Angle-closure glaucoma
Overview
• To identify the primary
open-angle glaucoma
requires assessment of
the optic nerve,
intraocular pressure
measurement and
assessment of visual
fields.
Types of Glaucoma
• Primary open-angle
glaucoma - the most
common type. This is a
painless form of
glaucoma in which there
are no other obvious
symptoms and
pathological
• factors (for exp.
trauma or
inflammation).
Types of Glaucoma
• The names "open
angle glaucoma"
and "angle-closure
glaucoma" refers to
the angle formed
root of the iris (iris
root) and the
cornea (cornea) in
the anterior
chamber of the eye.
Types of Glaucoma
• Open-angle
glaucoma. The root
of the iris (iris root)
is separated from
the cornea and
remains in the
current intraocular
fluid to the angle of
the anterior
chamber and
through the trabeculae in
Schlemm's canal.
Types of Glaucoma
• Closed - angle
glaucoma - the
root of the iris is
pressed against the
cornea, closing
and obstruktiruya
trabecular system
and thus closing
angle.
Types of Glaucoma
• What is meant
when the angle of
the eye diagnosis
of "closed - angle
glaucoma" and
"open-angle
glaucoma?" What
formed this angle?
Types of Glaucoma
• 1. The root of the iris,
ciliary body and lens
zonulami
• 2. The root of the iris
and the cornea in the
anterior chamber
• 3. The rear surface of
the pupillary edge of
the cornea and the
front surface of the
lens
Types of Glaucoma
• Angle in the
selected area is a
closed angle. The
root of the iris
adherent to the
cornea, and
covering
obstruktiruya
trabecular system
and thereby closing
angle.
Types of Glaucoma
• Dedicated angle is open.
The root of the iris is
spaced from the front of
the camera and does not
cover the current
intraocular fluid through
the trabeculae in
Schlemm's canal in the
corner of the front
chamber of the eye.
Открытоугольная глаукома
• IOP increased (normal 16-21mm. Hg)
• Cup of ON disk
• Reduced visual fields: normal:
LE
65
RE
65
90
55
55
90
60
60
Red Eye. Closed angle glaucoma.
• angle-closure glaucoma
• Classically, the patient
complains of severe,
constant pain in the eye,
accompanied by nausea
and vomiting.
• On examination: 1) the
ciliary injection of 2)
moderately extendedtion slightly uneven
pupil;
• 3) corneal edema
4) increase of IOP
Red Eye. Closed angle glaucoma.
• As a result of
corneal edema
patient noted blurred
vision and iridescent
circles around lights.
Acute attack glaucoma
•
•
•
•
•
•
•
Typically, in elders
Usually one-sided pain in the eye
Decreased vision redness of the eye
Nausea and vomiting
Bright circles around lights
Fixed wide pupil
Sensation of tension in the eye
Closed angle glaucoma.
• Anterior chamber is gradually
narrowed as a result of the growth of
the lens. The lens is gradually
increasing over the life of a person,
resulting in the production of new
fibers inner surface thereof capsules.
Red Eye. Closed angle glaucoma.
• Treatment: recognition of pathology and referral
to an ophthalmologist. Starting immediate
treatment aimed at reducing the intraocular
pressure (ocular drops -beta-blockers; carbon
anhydrase inhibitors, ophthalmic drops miotikami; osmagents system). These drugs are
used to reduce intraocular pressure and get rid of
corneal edema in preparation for laser iridotomy
or iridectomy surgery.
Closed angle glaucoma
• In a small-sized eye, with an increase in the
lens anterior chamber angle becomes
smaller and narrower. This may be a
predisposing factor for the development of
acute closed angle glaucoma.
• On the other hand in a larger size eye lens
growth may not lead to significant changes
in the depth and angle deeper anterior
chamber.
Primary open angle glaucoma
• Primary open angle glaucoma is the most
common form of glaucoma. It occurs
without symptom.
• It can be diagnosed by any attentive
physician have some knowledge and
understanding of the nature of the disease
with the use of the ophthalmoscope.
Primary open angle glaucoma
• The figure shows the
glaucomatous excavation
pits of the optic nerve and
other features:
• Vertical grade or elongation
(vertical bias or elongation)
• Nasal displacement of the
vessels (Nasal shift of
vessels)
• Serrated rim (rim notching)
Primary open angle glaucoma
• Pallor rim (rim pallor)
• Physiological
excavation area is
more than 50% (cup
area greater than
50%)
• Influence on the
fringe of the vessels
(rim effect on
vessels)
• Hemorrhage to disk
(not shown in the
figure)
Primary open angle glaucoma
• Key points:
• As a rule, the higher the intraocular
pressure, the greater the likelihood of
damage to the optic nerve
• Warning! Due to the fact that IOP varies
throughout the day, in some patients, a
single measurement can not be detected by
pressure increase at a specific time of the
day
Primary open angle glaucoma
• Key points: A positive family history is a risk
factor for the possible development of glaucoma.
• Glaucoma is more common in first-degree
relatives (family members), but the pattern of
inheritance is not installed.
• Glaucoma occurs in about 5% of the population
older than 50 years.
• Be careful! Glaucoma can occur in patients up to
40 years.
Primary open angle glaucoma
• Open-angle glaucoma is more common
in patients with myopia.
• Whereas closure glaucoma associated
with hyperopia.
DIAGNOSTIC
• To determine the presence of
glaucoma uses three diagnostic
procedure
1. tonometry
2. ophthalmoscopy
3. perimetry
Primary open angle glaucoma
Treatment
• Here is a list of commonly used surface /
systemic drugs for the treatment of
glaucoma:
1) beta-adrenergic blockers (eg. Timolol)
2) Adrenergic antagonists (eg. Epinephrine)
3) miotikami (eg. Pilocarpine)
4) carbonic anhydrase inhibitors
DIAGNOSTIC
Confirmation of the diagnosis of glaucoma
using tonometry and perimetry can be done
by an ophthalmologist. To perform these
diagnostic tests requires more expensive
equipment and special skills. Some risk
factors associated with primary open-angle
glaucoma:
Age older than 50 years myopia
Increased intraocular pressure
The presence of a family history of the disease
DIAGNOSTIC
• Angle-closure glaucoma diagnosis is made
by characters (moderately advanced, slightly
uneven pupil, cloudy cornea, increased
intraocular pressure) and symptoms
(throbbing pain, blurred vision, rainbows
around lights, nausea and vomiting).
• This condition requires immediate referral to
an ophthalmologist for the prevention of
blindness as a result of ischemia of the optic
nerve as a result of increased intraocular
pressure.
Treatment
• Treatment of closed - angle
glaucoma - surgical. Laser
iridotomy or surgical
peripheral iridectomy.
• Iridotomy provides for a
blocked outflow of
intraocular fluid in the area
of the pupil (the closure of
the anterior chamber angle
results in papillary block).