PRIMARY ANGLE CLOSURE GLAUCOMA Flashcards
WHAT IS PACG
PACG is a bilateral disease in which elevation of IOP occurs due to closure of angle by peripheral iris
what are the predisposing factors
ANOTOMICAL FACTORS:-
1-Axial lenght of eyeball is shorter than the normal individuals
2-corneal diameter is 0.25mm smaller than normal eye
3-iris lens diaphragm has anterior location
4-narrow entrance of the chamber angle for aqueous drainage
5-most commonly occurs in patients with hyperopia
GENERAL FACTORS:-
1-age,
2-females
3-race
4-typeof peronallity
What are the precipitating factors
1-dim illumination
2-emotinalstress
3-use of mydriatic drug
Stages of PACG
1-latent or primary angle closure suspect
2-subacute or intermediate angle closure
3-acute angle. closure
4-chronic angle closure
5-absolute glaucoma
PAC suspect
patient is symptom free
IOP is normal
anterior chamber depth is less than normal
provocative test may be positive
gonioscopy shows narrow angle capable of closure
TREATMENT;-
1- laser peripheral irodotomy
2-peripheral scleral irodotmy
SUBACUTE OR INTERMEDIATE ANGLE CLOSURE GLAUCOMA
this stage is charactorized by episodes of blurred vision halos and mild pain caused by elevated IOP
clinical features:-
1-periodic episodes of blurred vision mild pain halos
2-physiological mydriassi cause rise of IOP 40 to 45mmhg
3-the attack is usually broken after
1-2 hrs by physilogical misosis
4-IOP is normal btw episodes
5-gonioscopy shows narrow angle
6-provocative test is positive
TREATMENT:-
1- during attack pilocarpine 2% is given
2-after attack prophylactic peripheral iridotomy
ACUTE PRIMARY ANGLE GLAUCOMA
This stage is charactorized by severe elevation of intraocular pressure as a result of sudden closure angle of the anterior chamber(trabecular meshwork blocked by iris)
cause by same mechanism as in subacute glaucoma but not return to normal by physiological factors the high pressure causes ischemia of iris which release prostaglandins which produce sign of inflammation
clinical features:-
1-painin eye and periocular region
2-perception pf halos
3-vision deteriation
4-nausea and vomiting
5-redness of eye,waTERING AND PHOTOPHOBIA
6-previous history of halos
signs of ACUTE STAGE
1-visual acquity is reduced
2-raised IOP 70mmHg or above
3-conjuctiva is red and congested limbus shows marked ciliary congestion
4-cornea is cloudy
5-aqueous flare is present
6-pupil is ventrically oval,semi dilated position
7-iris show atrophic patches
8-lens shows glaukomflecken
9-gonioscopy;shows abnormally narrow angle with or without anterior synchiae
10-gonioscopy of fellow eye shows narrow occluded angle
DIAGNOSTIC POINTS OF ACUTE STAGE
1-raisedIOP
2-hazy cornea
3-decreased visual acquity
4-shallow anterior chamber
5-pupil verticall oval semi dilated fixed and unresponsive to light
6-optic disc hyperemia
7-gonioscopy anterior chamber angle closure
what is the treatment plan in acute stage
as it is a life threatening emergency delay in treatment can cause blindness s=due to optic atrophy
1-to control acute attack
2- to prevent future attack in affected eye
3- to prevent future attack in fellow eye
medical thearpy:-
1- pilocarpine when iop is lowere o 45mmHg
2-acetazolamide
3-hyperosmotic agents eg mannitol and glyecerol
4- analgesics
5- antiemetics
TOPICAL THERAPY:-
1-pilocarpine 2% dose 4 times a day
2-beta blocker eg timolol twice a day
3-alpha 2 agonist
4-topical carbonic anhydrase
5-topical steroids
PREVENTION OF FUTUTRE ATTACK:-
1-Laser irodotomy-when more thn 50% of angle is open
2-trabeculotomy-when more than 50% of angle is closed
PREVENTION OF FUTURE ATTACK IN FELLOW EYE:
PROPHYLACTIC LASER IRODOTOMY
SURGICAL IRDECTOMY
CHRONIC ANGLE CLOSURE GLAUCOMA
This stage develops after second and third stage of PACG in which anterior synchiae persist.it may also develop when anterior chamber angle closes gradually snd IOP rises slowly as angle function is progressively compromised
cliniCal features:-
1-anterior chamber is shallow
2-gonioscopy shows variable degree of angle closure with the presence of peripheral anterior synchaie
3-IOP remians continuously elevated and does not show fluctuation as in POAG
TREATMENT;-
1-ANTIGLAUCOMA DRUG TO LOWER IOP
2-LASER IRODOTOMY
3-TRABECULOTOMY
ABSOLUTE GLAUCOMA
it is the end stage of closure glaucoma and all the other forms od glaucomao .This term is used to describe painful or painless hard blind eye
clinical features:-
1-in visual acquity no perception of light
2-IOP is raised
3-usually painful but maybe painless
4-ciliary congestion may be present
5-anterior chamber is shallow,pupil is dilated and nonreactive to light
6-optic disc shows optic atrophy(full cupping)
TREATMENT OF ABSOLUTE GLAUCOMA
1-ANTIGLAUCOMA DRUG
2-RETOBULBAR ALHOL INJECTION TO CILIARY GANGLION
3- CYCLOCRYOTHERAPY
4-DIODE LASER ABLATION
5-FILTERATION OPERATION-TRABECULOTOMY WIH MMC
6-ENUCLEATION OF EYEBALL
