#46. Congenital glaucoma. Secondary glaucomas - pigmentary, pseudoexfoliative, neovascular and traumatic. Flashcards
What is CONGENTIAL GLAUCOMA?
1) Is the ABNORMAL INCREASE in INTRAOCULAR Pressure during FIRST YEARS OF LIFE
2) Causes DILATION of GLOBE WALL + CORNEA
3) Resulting in
- BUPHTHALMOS (Abnormally Large Eye)
- HYDROPHTHALMOS (PROGRESSIVE INCREASE in CORNEAL DIAMETER)
What are the CAUSES of CONGENITAL GLAUCOMA?
- Is Congenital
- HYDROPHTHALMIA with Ocular Developmental Anomalies
- HYDROPHTHALMIA with Systemic Disease
- SECONDARY
What are the CAUSES of CONGENITAL GLAUCOMA?
- Is Congenital
- HYDROPHTHALMIA with Ocular Developmental Anomalies
- HYDROPHTHALMIA with Systemic Disease
- SECONDARY BUPHTHALMOS due to ACQUIRED Eye Disorders
What are the SYMPTOMS of CONGENITAL GLAUCOMA?
- Photophobia
- Epiphora
- Corneal OPACIFICATION
- Unilateral / Bilateral ENLARGEMENT of Cornea
What is the DIAGNOSIS for CONGENITAL GLAUCOMA?
1) Corneal Diameter is 14.0mm (Normal = 9.5mm)
2) Stromal Opacities are SEEN
3) MEASURE Intraocular Pressure
4) OPTIC DISK OPHTHALMOSCOPY
- OPTIC CUP is an indicator for INTRAOCULAR PRESSURE, esp. for PERMANENT Visual Field Defect
- ASYMMETRY of the OPTIC CUP
5) INSPECTION of CORNEA
- Cornea appears WHITISH / OPACIFIED due to EPITHELIAL OEDEMA
- BREAKS in DESCEMET’S MEMBRANE can indicate as EPITHELIAL / STROMAL Oedema
- LESIONS called HAAB’s STRIAE exhibit TYPICAL HORIZONTAL Configuration
- If there’s an ENLARGED Corneal Diameter (Normal = 9.5mm)
6) GONIOSCOPY of ANGLE of ANTERIOR CHAMBER
- Embryonic Tissue will OCCLUDE TRABECULAR Meshwork
What is the DIFFERENTIAL DIAGNOSIS of CONGENITAL GLAUCOMA?
- Large Eyes
- Corneal Opacification
What is the TREATMENT for CONGENTIAL GLAUCOMA?
SURGICAL TREATMENT via
- Goniotomy = cutting the fibres of the trabecular meshwork to allow aqueous fluid to flow more freely from the eye
- Trabeculotomy = drain fluid out of the eye and into a small blister, under the surface of the eye
** PROGNOSIS IS IMPROVED the EARLIER the Surgery is performed
What is SECONDARY GLAUCOMA?
Glaucoma that’s CAUSED BY OTHER Ocular Diseases such as;
- Inflammation
- Trauma
- Bleeding
- Tumours
- Medication
What are the 2 MAIN Types of SECONDARY GLAUCOMA?
1) Secondary OPEN ANGLE Glaucoma
2) Secondary ANGLE CLOSURE Glaucoma
What is Secondary OPEN ANGLE Glaucoma?
ANATOMIC Relationship BTW:
- ROOT of Iris
- Trabecular Meshwork (congested)
- Peripheral Cornea
What are the 5 FORMS of Secondary OPEN ANGLE Glaucoma?
a. Pseudoexfoliative Glaucoma
b. Pigmentary Glaucoma
c. Cortisone Glaucoma
d. Inflammatory Glaucoma
e. Phacolytic Glaucoma
Describe Pseudoexfoliative Glaucoma
- DEPOSITS of AMOPRHOUS Acellular Material
- FORM throughout the ANTERIOR CHAMBER + CONGEST the Trabecular Meshwork
Describe Pigmentary Glaucoma
- Occurs in YOUNG MYPOIC Men
- RELEASE of PIGMENT GRANULES from PIGMENTARY EPITHELIUM of the IRIS that CONGEST the Trabecular Meshwork
Describe Cortisone Glaucoma
- 35 - 40 % of Popp. REACT to 3 Week TOPICAL / SYSTEMIC Steroid Therapy
- ELEVATED INTRAOCULAR Pa
- INCREASED Deposits of MUCO-PS’s in Trabecular Meshwork TO INCREASE RESITANCE of OUTFLOW
Describe Inflammatory Glaucoma
- INCREASED INTRAOCULAR Pa via INCREASED VISCOSITY of AQUEOUS HUMOUR, DUE to PROTEIN INFLUX from INFLAMED Iris Vessels
- INCREASED INTRAOCULAR Pa via CONGESTED Trabecular Meshwork consisting of INFLAMMATORY CELLS + CELLULAR DEBRIS
