Ophthalmology >
Glaucoma

“Group of conditions which share characteristic changes in visual field and optic nerve head”

Risk Factors
  • Age (risk increases with age)
  • Ethnicity (persons of African, Caribbean and Asian origin at higher risk)
  • Family history (likelihood increases if first degree relative has the condition)
  • Other medical conditions (diabetes, hypertension, myopia, hypermetropia)
  • Corticosteroid use
  • Eye injury/surgery
Aetiology
  • Primary glaucoma – mechanism unknown
  • Secondary glaucoma – secondary to another ocular disease
Pathophysiology
  • Increase in intraocular pressure (IOP) above 21mmHg, where fluid in the eye is unable to drain properly → chronic elevation in IOP damages optic nerve → selective loss of retinal neurones
Clinical Presentation
  • Usually asymptomatic at first, edges of peripheral vision affected initially
  • Blurred vision, seeing rainbow-coloured circles around bright lights
  • Both eyes are normally affected
  • Can develop suddenly causing eye pain, blurred vision, visual disturbances, red eye, nausea and vomiting, eye tenderness
Investigations
  • Eye pressure test → tonometry
  • Gonioscopy → looks at the “angle” (where fluid drains out), can indicate the type of glaucoma
  • Visual field test
  • Optic nerve assessment: slit lamp microscope, optical coherence tomography (OCT)
Management
  • Eye drops (Prostaglandin analogues, beta-blockers, alpha-adrenergic agonists, carbonic anhydrase inhibitors or combination drops)
  • Laser treatment
  • Surgical treatments
Complications
  • Loss of vision
  • Complications from treatment (infections after surgical treatment)

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