GlaucomaGlaucoma

Dr.Somboon Panyakorn Dr.Somboon Panyakorn

Cause of BlindnessCause of Blindness

It is a group of diseases in which damage to the retinal ganglion cell caused by raised intraocular pressure

Anatomy Anatomy

Anatomy Anatomy

Anatomy Anatomy

GLAUCOMAGLAUCOMA

Aqueous Humor Dynamics Produced by non-pigmented epithelia Produced by non-pigmented epithelia

of pars plicataof pars plicata SecretionSecretion UltrafiltrationUltrafiltration DiffusionDiffusion

Aqueous production rate - 2µL/minAqueous production rate - 2µL/min Facility of outflow – 0.22µL/min/mm Facility of outflow – 0.22µL/min/mm

of Hgof Hg

Factor Affect IOPFactor Affect IOP Age Age RACERACE Family historyFamily history Exercise Exercise Drug Drug Refractive error Refractive error Inflammation Inflammation SurgerySurgery

Normal IOPNormal IOP

Mean= 15.9mmHg ± 2 SD

IOP > 21 is abnormal.

Tonometers

GoldmannContact applanation

PerkinsPortable contact applanation

Pulsair 2000 (Keeler)Air-puff

Schiotz

Portable non-contact applanationNon-contact indentation

Contact indentation

Tono-Penportable contact applanation

Enlarge cuppingEnlarge cupping

STRUCTURE /FUNCTION EVALUATIONSTRUCTURE /FUNCTION EVALUATION

THE VISUAL FIELDTHE VISUAL FIELDHumphrey automated perimetry

Clinical symptomClinical symptom

Clinical symptomClinical symptom

Ocular hypertensionOcular hypertension IOP higher than normal in the absence of IOP higher than normal in the absence of

optic nerve damage or visual field lossoptic nerve damage or visual field loss 10% turn to glaucoma in 5 years10% turn to glaucoma in 5 years

Treatment Treatment Beta blocker : 0.5% timololBeta blocker : 0.5% timolol Alpha agonist : brimonidine Alpha agonist : brimonidine Carbonic anhydrase inhibitor : Carbonic anhydrase inhibitor : dorsolamide,acetazolamidedorsolamide,acetazolamide Prostaglandin : Prostaglandin : latanoprost,bimatoprost,travaprostlatanoprost,bimatoprost,travaprost

GLAUCOMAGLAUCOMASurgical treatment of glaucomaSurgical treatment of glaucoma

Argon laserArgon lasertrabeculoplastytrabeculoplasty

FiltrationFiltrationproceduresprocedures

GLAUCOMAGLAUCOMAFiltration blebsFiltration blebs

Screening Screening Age > 40Age > 40 Family historyFamily history Underlying disease DM HT CRF etcUnderlying disease DM HT CRF etc On medication On medication History of trauma History of trauma Sign and symptom suspected glaucomaSign and symptom suspected glaucoma

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