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Glaucoma :blue_heart: (Risk factors (Intraocular pressure (IOP) (Diurnal…

- - - - Look at Physiologic cup & Neuroretinal rim
      - entire thing divided into 10 equal parts
      - Optic disc change in glaucoma
        
        Enlargemnt of cup & Elongation of cup
        
        Localized or Generalized loss of neuroretinal rim tissure
        
        Asymmetry of optic cup
        
        Disc hemorrhage
        
        Peripapillary atrophy (PPA)
    - - Direct/Indirect ophthalmoscopy
      - Disc/Fundus photograph
      - Optic Coherence Tomography (OCT)
      - :womans_hat:can see Retinal nerve fiber layer
    - - check Visual field
      - For Dx, evaluation of severity and F/U
      - Glaucomatous VF defect
        
        Generalized depression
        
        Paracentral scotoma
        
        Arcuate scotoma
        
        Nasal step
        
        Altitudinal defect
        
        Temporal wedge
        
        :!: vs Neurological defect
- - - - Normal variation 2-6 mmHg
      - Diurnal fluctuation > 10 mmHg ➭ suggests Glaucoma
      - Peak in the morning hr
      - Position affect IOP
    - - :star:Goldmann applanation tonometry:star:
      - Schiotz tonometry
      - Noncontact (air-puff) tonometry
      - Digital pressure
- - - - Conventional system (Trabecular meshwork)
        
        Traditional pathway
        
        Pressure dependent
        
        3 layers
        
        Uveal meshwork
        
        Corneoscleral meshwork
        
        Juxtacanalicular meshwork
      - Unconventional system (Uveoscleral pathway)
        
        5-15%
        
        Pressure-independent
        
        Supraciliary space, ciliary ms, suprachoroidal space, choroidal vss, emissarial canal, sclera and lymphatic vss
  - - - by Goniolens/prism
- - - - Lens-induced glaucoma
        
        Open-angle
        
        Phacolytic glaucoma
        
        Lens particle glaucoma
        
        Phacoantigenic glaucoma
        
        Angle-closure
        
        Phacomorphic glaucoma
        
        Ectopia lentis
      - Ocular inflammation
        
        :gear:Mec. of Open-angle inflammatory glaucoma
      - Accidental & surgical trauma
      - Elevated episcleral venous pressure
        
        AV malformation
        
        AV fistula
        
        Orbital varied
        
        Spurge-Weber syndrome
        
        Venous obstruction
        
        Retrobulbar tumor
        
        Thyroid-ass. orbitopathy
        
        SVC syndrome
        
        Idiopathic (familial)
      - Drugs-induced glaucoma
        
        Open-angle
        
        Corticosteroid
        
        Angle-closure
        
        Topiramate (Topomax)
      - Others: neovascular glaucoma, thyroid ds, tumor (intraocular/retrobulbar), fibrin material (exfoliation syndrome), pigment (pigmentary glaucoma)
  - - - Dx
        
        High IOP ➯ POAG
        
        Normal/Low IOP ➯ NTG/LTG
      - RFs
        
        Advanced age
        
        Black race
        
        Positive FxHx with POAG
        
        Myopia
        
        Cardiovascular RFs
        
        +-DM
    - - CACG
      - AACG
      - RFs
        
        Asian race
        
        Ocular biometry: small crowded anterior segments & short axial length
        
        Advanced age
        
        Gender :womens: 2-4x
        
        FxHx
        
        Hyperopia
      - Symptoms
      - Signs
      - PathoPSO
        
        Predisposing factors
        
        Precipitating factors
      - Treatment
        
        Immediate
        
        :arrow_down: IOP + relief symptoms
        
        Reopened angle ( :arrow_down: pressure gradient): laser iridectomy
        
        Preserve visual function
        
        Control IOP
        
        Medication
        
        Mechanism
        
        :arrow_down: aqueous production
        
        :arrow_up: aqueous outflow
        
        Classification :heartbeat::star:
        
        Beta-adrenergic antagonists
        
        Adrenergic agonists
        
        Carbonic anhydrase inhibitors
        
        Prostaglandin analogs
        
        Parasympathomimetic agents
        
        Combination drugs
        
        Mx decision ➯ Tailor therapy
        
        Based on
        
        Efficacy
        
        Safety
        
        Tolerability
        
        Laser
        
        Angle closure
        
        Laser iridotomy
        
        Laser iridoplasty
        
        Open angle
        
        Laser trabeculoplasty
        
        Laser cyclophoto destruction: Ablate ciliary body ➯ :arrow_down: aq. production
        
        Surgery
        
        I/C
        
        Med therapy is not appropriated, not tolerated, or not effective
        
        Uncontrolled IOP, progressive damage
        
        Goal: :arrow_down: IOP
        
        Type
        
        Trabeculectomy (Filtering Sx)
        
        3 more items...
        
        Glaucoma drainage device
        
        Complication
        
        Infection: blebitis, endophthalmitis
        
        Hypotony
        
        2 more items...
        
        Overdrainage
        
        Leakage
        
        Ciliary shutdown
        
        :arrow_up: IOP
        
        :arrow_down: vision
        
        🎯 Target IOP