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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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