Refrat

GLAUCOMA

Yelin Julita, S.Ked

Pembimbing :

dr. Rachmad Syuhada Sp. M

 Definition Of Glaucoma
Glaucoma is a condition that causses optic nerve
damage. It often associated with :
•The increase of Intraocular pressure
•optic nerves papil atrophy
• narrowing of visual field.
 ANATOMY OF ANGULO IRIDOCORNEALIS

Is the anatomical angle

created by the root of the
iris and the peripheral
corneal vault.

Within it lie the structures

involved in the outflow
passage of the aquoes,
namly trabecular
meshwork and the
schlemm’s canal.

1.
The aqueous humor is secreted by the ciliary epithelium, which in addition to
secreting aquous humor and providing nutrients to the lens and cornea it
provides struktural support and helps to keep the shape of the eye -- so that
fluid’s into the posterior chamber, and then flows through a narrow space
between the front lens and the back of iris through the pupil -- to the anterior
chamber – the fluid flows out of the eye through the TM, -- to the CS –
FINALLY into AV that are part of the EVS
SCALP EXAMINATION
In Glaucoma, part of this aqueous humor drainage pathway becomes
partially of completely blocked, SO THAT FLUID CAN’T EASILY
DRAIN OUT
The high pressure affects all of the structures in the eye, including the optic
nerve, which is the nerve that carries visual information from the eyes to
the brain, and this means that over time as the optic nerve gets damaged,
glaucoma leads to vision loss.
 CLASSIFICATION

• Primary Glaucoma
• Secondary glaucoma
• Congenital Glaucoma
• Absolute Glaucoma
 A. OPEN-ANGLE GLAUCOMA

The most common type of glaucoma. this is called

open-angle glaucoma because of there is a
tunnel in trabecular meshwork. Usually bilateral,
not necessarily symmetrical
 The angle between the cornea and the iris is OPEN, in this type, the
drainage system slowly gets clogged over time, so there’s gradual increase
in pressure on the optic nerve. This increase in pressure initially results in
atropy of the outer rim of the nerve, resulting in a decrease in peripheral
vision as that pressure increases even more though, there’s continued
damage the optic nerve which eventually loss in central vision as well
 OPEN-ANGLE GLAUCOMA
Characterized by : Risk Factors :

• Adult onset • Age

• Progressive deacrease • History of eye surgery
Vision • Family history
• IOP > 21 mmHg
Glaucomatous optic • myopia
nerves damage
• Visual field loss
• Open angle of normal
appearance
 A.OPEN-ANGLE GLAUCOMA

• Pathogenesis : Elevated IOP in POAG results

from increased resistance within this aquos
drainage system.
Symptoms :
• Commonly asymptomatic, detected incidentally.
• Rarely, headache and ocular pain with mild
blurring of vision due to transient corneal
oedema
• Occasionally, early visual defects can be
discovered by chance.
 B. Closed-Angle Glaucoma

Closed angle glaucoma is a condition in which the

pressure inside the eye becomes too high.
In closed angle glaucoma, the trabecular meshwork is
obstructed and damaged. The fluid can’t flow easily
through this drainage pathway.
 This is due to the angle between the iris of the cornea being to small,
meaning that the passageway for aquous humor outflow is too narrow, and
this is as a result of the lens being pushed up againts the iris – Drainage
Blocked but this causes a RPB in the eye – causing an abrupt of severe eye
pain
 C. Congenital Glaucoma

Appear at birth or first year of life. The clinical

manifestations are :
•Excessive watery eyes
•Increase of cornea diameter (buftalmos)
•Cloudy cornea because of ephitel oedema
•Photophobia
•Increase of IOP
•Increase of COA depth
•Optic disc curved
 D. Absolute Glaucoma

This condition is the end stage of glaucoma. Where happened

total blind. Clinical manifestations are :
•Total blind
•Cloudy cornea
•Shallow COA
•Papil atrophy with glaucomatosa excavatation
•Periorbital pain
•eyestrain
 Supporting Assesment
1. Tonometri
- Tonometri palpation
- Tonometri Schiotz
- Tonometri aplanasi
goldman
2. Gonioscopy
3. Ophtalmoscopy
4. Visual field
examinaation
5. Provocation test
 MANAGEMENT
1. Medication
•Beta blocker
•Karbonik anhydase inhibitor
•Agonis alfa adrenergic
•Parasimpatomimetik (miotik)
•Analog prostaglandin
2. Surgery

•Trabeculopaty laser
•Iridektomy or
•pheriperal iridotomy
•Drainage
•siklodestructive
 CONCLUSION

- Glaucoma is a disease in which a complete clinical picture is

marked by elevation of intraocular pressure.

• Glaucoma is called a "vision thief" because it develops without

being marked by obvious symptoms. Therefore, half of glaucoma
sufferers do not realize that they suffer from the disease. Open-
angle glaucoma needs to watch out for people: age 40 years or
older, people with diabetes mellitus, in families there are people
with glaucoma, high myopia.

• Glaucoma examination, namely: examination of eye pressure

(Schiotz tonometry, implantation tonometry, digital tonometry),
gonioscopy,ophthalmoscopy, visual field examination, provocation
test. Themanagement of glaucoma is done in 2 ways, medical and
operative.
THANK YOU