Glaucoma

glancomaribers to a group of ocular conditions characterizedby elevated IOP.if 0 tx- 10p=damage to rptic nerveand neme b iber layer*damage IS caused by congestion of aqueonshumor in the eye.affects 3million amemans -50% go undi agnosedmore prevalant in people 740 years old.There IS 0 cure for glaucoma.aqueous humor usually blows between the in sand the lens nonrishing the cornea and lens.90% of the bluid then b lows out of the antenor chamber,draming through the sponger trab emlar meshworkinto the canal of Schelm and the episeleral runs.10% fluid exits through the elliany body into thesuprachoroidal space and then draws into thevenons circulationfor drainage to flow out 40 185ml, there needs to bean Intact dranage system and an open angle(450) between the Iris and the comer.- aqueous humor&c/age, diabetes, owlar inflammatoryconditions normal lop = 10-21 mmHgFluctuations in 10 P are d/+ time of day, exertion, diet,medicationslop usually T/: blinking,tight lid squeezing,upward gavingRISK factors of glauomablack/ asian racecardiovascular diseasedeabetesfamily hx of HancomaMigraine 8/5myopia (nearsightedness)OSAolder ageprevious eye traumapholonged use of topical or systemic corticosteroidethin cornea.2 theories oflop damages the optic name.110P damages the retinal layer asIt passes through the UP hiu name head.2indirect Ischemie suggests that lop compressesthe microcarculation inthe optic here head, resulting In cell injury and death.S/S:blumed visionhalos arrund lights- of Obiculty fousingdifficulty adjustingeyes lh low lightloss of penpheral visionaching /discomfort anrudthe eyesHApallor of the optic neme TABLE 58-Glaucoma Types, Clinical Manifestation, and4TreatmentTypes ofClinical ManifestationsTreatmentGlaucomaWide AngleUsually bilateral, but one eye may be more severely affected than theother. In wide-angle glaúçoma; the anterior chamber angle isopen and appears normal.Normal-IOP <21 mm Hg. OpticIf medical treatment istensionnerve damage, visualunsuccessful LT canglaucomafield defects.decrease IOP by. 20%.Glaucoma filteringsurgery if continuedoptic nerve damagedespite medicationtherapy and LT.OcularElevated IOP. PossibleThe best managementhypertensionocular pain or headache.for normal-tensionglaucomamanagement is yet tobe established. Goalis to lower the IOP byat least 30%.Narrow AngleObstruction in aqueous humor outflow due to the complete or partialclosure of the angle from the forward shift of the peripheral iris tothe trabecula. The obstruction results in an increased IOP.Acute angle-Rapidly. progressive visualOcular,emergency;closuréimpairment, periocularadministration ofglaucomapain, conjunctivalhyperosmotics,andacetazolamide and ...Acute angle-Rapidly. progressive visualOcular.emergency;closureimpairment, periocularadministration ofglaucomapaín, conjunctivalhyperosmotics,hypéremia, andacetazolamide, andcongestion. Pain may betopical ocularassociated with nausea,hypotensive agents.vomiting, bradycardia,Possible laserand profuse sweating.Reduced central visualthe iris) to release releaseiridotomy (incision inacuity, severely elevatedblocked aqueous andIOP, corneal edema.reduce IOP. Other eyePupil is vertically oval,is also treated withfixed in a semidilatedpilocarpine. eye dropsposition, and unreactiveand/or surgicalto light andmanagement to avoidaccommodation.a similar spontaneousattack.SubacuteTransient blurring ofProphylactic peripheralvision, halos aroundlaser iridotomy. Canclosurelights; temporallead to acute orglaucomaheadaches and or ocularchronic angle-closurepain; pupil may beglaucoma ifsemidilated.untreated.Chronic angle- Progression ofManagement includesclosureglaucomatous cuppinglaser iridotomy andglaucomaand significant visualmedications.field loss; IOP may benormal or elevated;ocular pain andheadache. medical tx:fouses on preventing optic nem damagePharmacologiclaser procedinesSXPharmacologicBeta. blockers preferred initial tonial medicationsmiotics - outblow of the agvers humor by affeelingcilliary muscle contraction and pupil constinction,allowing flow through G larger opening betweenthe Iris and trabecular meshworkalpha 2 agonestscarbonic anhydrase inhibitorsprostaglandins - aqueous humor outflowBeta blockers I carbonic anhydrase inhibitors:decrease agenons productionSX: minimally invance-improves fluid dramagefrom the eye to balance 101.Stabilines the optic name and minimiusfurther visual field damage.laser trabeuloplasty laser applied to inner surfaceof the trabuclear meshwork to open the intratrapecular spaces and miden the camal ofSchelmm = T outflow ol aqueons humor, IOP.filtering procedures-bypass usual dramagestructures, fluid drams/exits through different writes.complications: hemorrhage, extremely (hypotony)orextremely 10P, uvertis, cataracts, bleb b ailure,bleb leak ,and endophthalmits (Intraocular infection)Dranage implants or shunts areimplanted Ih the anterior chamber to shintagurous honor to the episcleral plate in theconjuctival space