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on Jul 19, 2012 Says :
wow... excellent presentation on glaucoma.
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GLAUCOMA CONTENS : DEFINITION AQUEOUS PARTH WAY TYPES EXAMINATIONS TREATMENTS Ruwanka Ahangama
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In the normal eye, there is a delicate balance between the inflow and outflow of aqueous. When the outflow is blocked, the intraocular pressure rises, leading to optic nerve damage. This condition is known as Glaucoma. Usually effects both eyes. What is glaucoma?
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Visual field loss Raised intraocular pressure Excavation or pathological cupping Glaucoma has 3 cardinal sings (Normal I.O.P range from 10 to 20 mm Hg)
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Increased intraocular pressure ischemia of optic nerve head retinal nerve fiber damage loss of visual field.
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The Aqueous Pathway Aqueous humor is produced by the ciliary body within the posterior chamber & it is important for maintaining the shape of the eye and providing nourishment for the vascular lens and cornea.
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After filling the posterior chamber, aqueous moves forward around the lens and flows through the pupil into the anterior chamber. As the anterior chamber fills, the aqueous spreads outwards through the trabecular meshwork into the Canal of Schlemm, where it returns back into the blood circulation.
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Open vs. Closed-Angle Glaucoma There are two categories of glaucoma and they have very different mechanisms. Open-angle glaucoma. (Chronic) Closed-angle glaucoma.(Acute )
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Open-angle glaucoma is the most common type. It occurs from blocked aqueous drainage caused by an unidentified dysfunction or microscopic clogging of the trabecular meshwork. This leads to chronically elevated eye pressure, and over many years, gradual vision loss. Open-angle glaucoma has the reputation of being the "sneaky thief of sight" because the visual loss occurs so slowly that many patients don't realize they have the disease until it is far advanced.
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The major risk factors of Open angle Glaucoma Family history Age Race High eye pressure Thin-corneas
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Closed-angle glaucoma, also called “acute glaucoma,” which occurs when the angle between the cornea and iris closes abruptly. With this closure, aqueous fluid can’t access the drainage pathway entirely, causing ocular pressure to increase rapidly. When the iris moves forward, the irido-corneal angle closes, blocking the trabecular meshwork. Without an exit pathway, aqueous fluid builds up, eye pressure increases rapidly, and the optic nerve is damaged from stretching and decreased blood supply.
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Acute Glaucoma Exam Techniques: Ophthalmologic examination for acute glaucoma involves measuring the eye pressure, accessing the anterior chamber angle, and a fundus exam. One trick to determine whether an angle is shallow is to shine a simple penlight across the eyes. If the iris is pushed forward, it will cast a shadow.
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On exam, we can find their pupil sluggish and mid dilated. Pressures in the affected eye can be very high, often 60 mm Hg or higher. The eye will feel rock hard, and you can actually palpate the difference between the eyes with your fingers. One classic sign that patients often describe is seeing halos around lights. This occurs because the cornea swells as water is pushed under high pressure through the endothelium into the corneal stroma.
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Checking Pressure The measurement of pressure Known as Tonometry. Instrument for measuring pressure Tonometer. Methods Goldmann tonometry Tono-Pen Non-corneal and Transpalpebral tonometry Non-contact tonometry
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Goldmann Tonometry Goldmann tonometry is considered to be the gold standard in tonometry and is the most widely accepted method of determining intraocular pressure.
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Fluress© will be used in this procedure (Fluorescein, Benoxinate HCl )
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Non-corneal and Transpalpebral tonometry
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Checking the Visual Field by automated perimetry
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The central vision is typically spared – in fact, late stage patients may have 20/20 central vision, but be otherwise legally blind because of peripheral blindness.
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Corneal Thickness can affect pressure measurement: When we measure the pressure in the eye, we are actually measuring how much resistance we get when pressing on the cornea. When press on a thick cornea the pressure will seem higher than it really is. The opposite is true for thin corneas.
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Treatment: Since IOP is the only risk factor we can treat, the primary treatment of glaucoma focuses on decreasing eye pressure to less than 20 mm Hg or even lower, depending upon the severity of disease. Treatment may be either medical or surgical. Medical Treatment Beta-blockers work by decreasing aqueous humor production at the ciliary body. Beta-blockers are most often used to treat open-angle glaucoma. Unfortunately, systemic side effects can occur from nasal absorption, making it especially important to ask the patients about history of asthma, COPD, and cardiac problems.
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Beta-blockrs for glaucoma
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Prostaglandin analogues like latanoprost (Xalatan™) are the newest of these glaucoma drugs, and they are very popular as a first-line agent. They work by increasing aqueous humor outflow.
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Surgical Treatment for Chronic Glaucoma If eye drops aren’t working, there are several surgical techniques available to relieve eye pressure. One common surgery is the trabeculectomy, where an alternate drainage pathway is surgically created. A small hole is cut through the superior limbus, so that aqueous can drain under the conjunctiva.
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If this surgery doesn’t work, a plastic tube-shunt can be inserted into the anterior chamber that drains to a plate fixed under the conjunctiva further back behind the eye.
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Several laser procedures can also help to release pressure. Argon laser trabeculoplasty (ALT) can be used to burn portions of the trabecular meshwork itself.
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A high intensity laser can burn a hole through the iris and create a communication between the posterior and anterior chambers. This relieves the pressure gradient
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This laser procedure is typically performed on both eyes because these patients are predisposed to having attacks in the other eye as well.
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Primary Open angle g...
Malignant glaucoma d...
Anatomy of Glaucoma
Secondary glaucoma ...
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