GLAUCOMA

1. GLAUCOMA

2. AIM glaucoma are among the heaviest diseases of eyes, taking the third place in the world among the reasons leading to irreversible blindness. Necessity of studying of the theme follows from the fact, that patients with this pathology can address to any medical expert.

3. GOALS Thestudentshouldknow: • During analysis of patients with this pathology it is necessary to pay students’ attention to the kind of an injection (stagnant or pericorneal) and character of pain in an eyeball at such urgent conditions, as a acute attack of iridocyclitis and acute attack of close-angle glaucoma. Differential diagnostics of these two conditions is very important, since presence of pericorneal injection and local pain testifies an inflammation of a vascular layer while the stagnant injection and high ophthalmotonus is a typical sign of close-angle glaucoma attack.

4. GOALS • The student should be able: • To find out the complaints and the short anamnesis of disease; • To check visual acuity of each eye; • To examine peripheral borders of fields of vision; • Ophthalmoscopy: direct.

5. Glaucoma • Glaucoma - is an eye disease that can characterize the state of the anatomy of the anterior chamber - open or closed. Therefore, there are two types of glaucoma: Open-angle glaucoma angle-closure glaucoma

6. Glaucoma • Glaucoma is a triad: • Optic nerve damage resulting from exposure • accompanied by elevated intraocular pressure • Typical fields of vision loss.

7. Types of Glaucoma Overview anatomy of the eye

8. Types of Glaucoma • What type of glaucoma is the most common? • 1) Open-angle glaucoma • 2) Secondary glaucoma • 3) Angle-closure glaucoma

9. Overview • To identify the primary open-angle glaucoma requires assessment of the optic nerve, intraocular pressure measurement and assessment of visual fields.

10. Primary open-angle glaucoma - the most common type. This is a painless form of glaucoma in which there are no other obvious symptoms and pathological factors (for exp. trauma or inflammation). Types of Glaucoma

11. Types of Glaucoma • The names "open angle glaucoma" and "angle-closure glaucoma" refers to the angle formed root of the iris (iris root) and the cornea (cornea) in the anterior chamber of the eye.

12. Open-angle glaucoma. The root of the iris (iris root) is separated from the cornea and remains in the current intraocular fluid to the angle of the anterior chamber and through the trabeculae in Schlemm's canal. Types of Glaucoma

13. Types of Glaucoma • Closed - angle glaucoma - the root of the iris is pressed against the cornea, closing and obstruktiruya trabecular system and thus closing angle.

14. Types of Glaucoma • What is meant when the angle of the eye diagnosis of "closed - angle glaucoma" and "open-angle glaucoma?" What formed this angle?

15. Types of Glaucoma • 1. The root of the iris, ciliary body and lens zonulami • 2. The root of the iris and the cornea in the anterior chamber • 3. The rear surface of the pupillary edge of the cornea and the front surface of the lens

16. Angle in the selected area is a closed angle. The root of the iris adherent to the cornea, and covering obstruktiruya trabecular system and thereby closing angle. Types of Glaucoma

17. Dedicated angle is open. The root of the iris is spaced from the front of the camera and does not cover the current intraocular fluid through the trabeculae in Schlemm's canal in the corner of the front chamber of the eye. Types of Glaucoma

18. Открытоугольная глаукома • IOP increased (normal 16-21mm. Hg) • Cup of ON disk • Reduced visual fields: normal: LE 65 RE 65 90 55 55 90 60 60

19. 4) increase of IOP angle-closure glaucoma Classically, the patient complains of severe, constant pain in the eye, accompanied by nausea and vomiting. On examination: 1) the ciliary injection of 2) moderately extended-tion slightly uneven pupil; 3) corneal edema Red Eye. Closed angle glaucoma.

20. Red Eye. Closed angle glaucoma. • As a result of corneal edema patient noted blurred vision and iridescent circles around lights.

21. Acute attack glaucoma • Typically, in elders • Usually one-sided pain in the eye • Decreased vision redness of the eye • Nausea and vomiting • Bright circles around lights • Fixed wide pupil • Sensation of tension in the eye

22. Closed angle glaucoma. • Anterior chamber is gradually narrowed as a result of the growth of the lens. The lens is gradually increasing over the life of a person, resulting in the production of new fibers inner surface thereof capsules.

23. Red Eye. Closed angle glaucoma. • Treatment: recognition of pathology and referral to an ophthalmologist. Starting immediate treatment aimed at reducing the intraocular pressure (ocular drops -beta-blockers; carbon anhydrase inhibitors, ophthalmic drops - miotikami; osmagents system). These drugs are used to reduce intraocular pressure and get rid of corneal edema in preparation for laser iridotomy or iridectomy surgery.

24. Closed angle glaucoma • In a small-sized eye, with an increase in the lens anterior chamber angle becomes smaller and narrower. This may be a predisposing factor for the development of acute closed angle glaucoma. • On the other hand in a larger size eye lens growth may not lead to significant changes in the depth and angle deeper anterior chamber.

25. Primary open angle glaucoma • Primary open angle glaucoma is the most common form of glaucoma. It occurs without symptom. • It can be diagnosed by any attentive physician have some knowledge and understanding of the nature of the disease with the use of the ophthalmoscope.

26. Primary open angle glaucoma • The figure shows the glaucomatous excavation pits of the optic nerve and other features: • Vertical grade or elongation (vertical bias or elongation) • Nasal displacement of the vessels (Nasal shift of vessels) • Serrated rim (rim notching)

27. Primary open angle glaucoma • Pallor rim (rim pallor) • Physiological excavation area is more than 50% (cup area greater than 50%) • Influence on the fringe of the vessels (rim effect on vessels) • Hemorrhage to disk (not shown in the figure)

28. Primary open angle glaucoma • Key points: • As a rule, the higher the intraocular pressure, the greater the likelihood of damage to the optic nerve • Warning! Due to the fact that IOP varies throughout the day, in some patients, a single measurement can not be detected by pressure increase at a specific time of the day

29. Primary open angle glaucoma • Key points: A positive family history is a risk factor for the possible development of glaucoma. • Glaucoma is more common in first-degree relatives (family members), but the pattern of inheritance is not installed. • Glaucoma occurs in about 5% of the population older than 50 years. • Be careful! Glaucoma can occur in patients up to 40 years.

30. Primary open angle glaucoma • Open-angle glaucoma is more common in patients with myopia. • Whereas closure glaucoma associated with hyperopia.

31. DIAGNOSTIC • To determine the presence of glaucoma uses three diagnostic procedure 1. tonometry 2. ophthalmoscopy 3. perimetry

32. Primary open angle glaucomaTreatment • Here is a list of commonly used surface / systemic drugs for the treatment of glaucoma: 1) beta-adrenergic blockers (eg. Timolol) 2) Adrenergic antagonists (eg. Epinephrine) 3) miotikami (eg. Pilocarpine) 4) carbonic anhydrase inhibitors

33. DIAGNOSTIC Confirmation of the diagnosis of glaucoma using tonometry and perimetry can be done by an ophthalmologist. To perform these diagnostic tests requires more expensive equipment and special skills. Some risk factors associated with primary open-angle glaucoma: Age older than 50 years myopia Increased intraocular pressure The presence of a family history of the disease

34. DIAGNOSTIC • Angle-closure glaucoma diagnosis is made by characters (moderately advanced, slightly uneven pupil, cloudy cornea, increased intraocular pressure) and symptoms (throbbing pain, blurred vision, rainbows around lights, nausea and vomiting). • This condition requires immediate referral to an ophthalmologist for the prevention of blindness as a result of ischemia of the optic nerve as a result of increased intraocular pressure.

35. Treatment • Treatment of closed - angle glaucoma - surgical. Laser iridotomy or surgical peripheral iridectomy. • Iridotomy provides for a blocked outflow of intraocular fluid in the area of the pupil (the closure of the anterior chamber angle results in papillary block).