Glaucoma
By : Rashid
كالم الدكتور الي قاله برا المحاضره اجتهاد شخصي للفايده
Aquous humor circulation
Glaucoma could be :
1-Congenital.
2- Infantile.
3- Juvenile.
4- Adult.
1ry Congenital glaucoma
● It is the bases for the name “ blue water”.
● Known as buphthalmos.
● Because the cornea and the sclera are more
elastic than adult, which reveal the choroidal
vessels as blue in color and hence the
name.
● Increased intra-ocular pressure is essential
to diagnose it.
Mechanism?
● Abnormal development of trabeculae mishwork “ growth of Barkan membrane
“ which obstructs the AH drainage leading to High IOP.
● maybe starting in utero or postnatally.
What is angle?
● The angle between the cornea and iris which is normally 45°
Triad of diagnosis PREVIOUSLY
1-high intra- ocular pressure.
2- defective visual field.
3- Atrophy of optic nerve and Cupping.
N:B in 2 categories of patients, it’s been found that some may have only high IOP,
whereas the others have defective visual field and atrophy of optic nerve
WITHOUT high IOP.
● 2 theories describe these 2 categories of patients.
1- Mechanical theory : this explains glaucoma in patients whom have only high
IOP and hence they are called “ Ocular Hypertensive” patients.
2-Ischemic theory : this explains glaucoma in patients whom are Normo-Tensive,
but with defective visual field and atrophy of optic nerve.
Conclusion : the right nomenclature for “ glaucoma” is OPTIC NEUROPATHY.
Role of lights and electronics to induce 1ry closure angle glaucoma
● When you are watching TV or phone or video games in a dark room, the
pupil widens and narrows many times, until after enough period it causes the
iris to adhere to the lens and block the drainage of AH.
● ALSO it pushes the iris and allows the AH to accumulate in the posterior
chamber which leads to increase in the intraocular pressure.
N:B patients with 1ry closure glaucoma, while sleeping their pupils re-open “
Parasympathetic "and allow some drainage of AH relieving the pressure.
2ry glaucoma
1- presence of hyphema for long rime leads to degeneration of cells membranes
and cause “ Ghost cell Appearance” accumulate on the trabeculae and obstruct
drainage of AH leading to High IOP.
2- Hypopion also.
3- glaucoma Capsulare also.
Open and closed angle glaucoma
Open angle is usually CHRONIC.
Whereas Closure “ Narrow” angle is usually ACUTE
2ry Closure angle glaucoma
● The angle maybe normal (45°), but the patient might have been suffering
{ Uveitis, Keratitis} which leads to adhesions like :
1- iris can adhere to the trabeculae meshwork causing “ Anterior Synechia”.
2- iris can adhere to the lenses causing “ posterior Syenchia”
2ry open angle glaucoma
● How DM causes it?
● Diabetic retinopathy leads to necrosis and release of growth factors, then
Neo-vascularization which maybe seen as “ Rubeosis Iridis” on the iris,
causing shrinking of the eye and tractional retinal detachment.
● N:B if rubeosis iridis is in the trabecular meshwork it causes 2ry angle closure
glaucoma.
N:B Steroid plays a role in open angle glaucoma :
1- oral steroids causes Cataract.
2- Topical steroids causes Glaucoma
Glaucoma Capsulare
Optic nerve atrophy and CUPPING
● Cupping may be Physiological ( 0.2 to 0.4).
● It is formed bt convergence of the retinal
fibers to form the optic nerve at the optic disc.
● So when the nerve fibers start to atrophy they
invade lamina cribrosa of the sclera and
causing pathologic Cupping increasing the “
CUP-DISC ratio”
● Open angle glaucoma is the most common type of glaucomas 90% of cases.
● “Open-angle” means that the angle where the iris meets the cornea is as wide
and open as it should be. Open-angle glaucoma is also called primary or
chronic glaucoma.
● Is caused by the slow clogging of the drainage canals, resulting in increased
eye pressure
● Has a wide and open angle between the iris and cornea
● Develops slowly and is a lifelong condition
● Has symptoms and damage that are not noticed.
Angle-closure glaucoma, a less common form of glaucoma:
Is caused by blocked drainage canals, resulting in a sudden rise in intraocular
pressure.
Has a closed or narrow angle between the iris and cornea
Develops very quickly.
Has symptoms and damage that are usually very noticeable.
● Demands immediate medical attention.
Neo-vascular glaucoma most commonly due to Diabetic retinopathy
1. Pre-rubeosis: Patients with Diabetic retinopathy or Central retinal vein
occlusion.
2. Pre – glaucoma: patients are asymptomatic, normal IOP.
3. 2ry open angle glaucoma :
NVA= Neo-vascularization of
the Angle
NVI= Neo-vascularization of
the Iris
2ry angle closure glaucoma :
PAS= peripheral Anterior Synichia