Anda di halaman 1dari 32

Acute Glaucoma


Glaucoma is a disorder in which increased
intraocular pressure damages the optic nerve.
Primary glaucoma refers to glaucoma that is
not caused by other ocular disorders.
Secondary glaucoma may occur as the result
of another ocular disorder or an undesired side
effect of medication or other therapy.

Aqueous humor circulation

The aqueous humor is formed by the ciliary
processes and secreted into the posterior
chamber of the eye
26 l per minute and a total anterior and
posterior chamber volume of about 0.20.4ml,
about 12% of the aqueous humor is replaced
each minute.

Aqueous humor circulation

According to the spesific pathofisiology

Risk factor

Intraocular pressure
Race/ ethnicity
Family history of glaucoma

Primary open angle glaucoma

structure of the trabecular look normal but an
increase in flow out of aqueous resistance which
causes increased ocular pressure
Etiology : drainage of aqueous humor is


Unspesific symptoms
Burning sensation in the eyes
Blurred or decreased vision

Secondary open angle glaucoma

The anatomic relationships between the root of
the iris, the trabecular meshwork, and peripheral
cornea are not disturbed.
The trabecular meshwork is congested and the
resistance to drainage is increased.

Primary angle closure glaucoma

Acute episodic increase in intraocular pressure
to several times the normal value (1020mm
Hg) due to sudden blockage of drainage.
Production of aqueous humor and trabecular
resistance are normal.

Acute onset of intense pain. The elevated
intraocular pressure acts on the corneal nerves
to cause dull pain.
Nausea and vomiting
visual acuity
Prodromal symptoms--blurred vision or the
appearance of colored halos around lights

Acute glaucoma attack: pupillary block

Conjunctival and ciliary injection (red eye).

Corneal edema.
Opacification of the corneal
Anterior chamber is shallow.
The pupil is oval instead of round and dilated.
Intraocular pressure is elevated; the eye is rock
hard to palpation.
Severe headache and gastrointestinal symptoms
are present.

Secondary angle closure glaucoma

In secondary angle closure glaucoma as in
primary angle closure glaucoma,the increase in
intraocular pressure is due to blockage of the
trabecular meshwork.
However, the primary configuration of the
anterior chamber is not the decisive factor.

Juvenile glaucoma
Any abnormal increase in intraocular pressure
during the first years of life will cause dilatation
of the wall of the globe, and especially of the
The result is a characteristic, abnormally large
eye (buphthalmos) with a progressive increase in
corneal diameter.


corneal opacification,
Unilateral or bilateral enlargement of the cornea.
These changes may be present from birth (in
congenital glaucoma) or may develop shortly
after birth or during the first few years of life.
Children with this disorder are irritable, poor
eaters, and rub their eyes often.


sudden decrease in visual acuity (visus <6/60)

Red eye, watery and fotofobia
Pain, nausea and vomiting
Increase of TIO (usually > 50mmHg)
Edem of cornea epitel and cloudy cornea
Dilatation of pupil
Shallow of anterior chamber

The major mechanism of visual loss in glaucoma
is retinal ganglion cell apoptosis, leading to
thinning of the inner nuclear and nerve fiber
layers of the retina and axonal loss in the optic
nerve. The optic disk becomes atrophic, with
enlargement of the optic cup

Increase of TIO induced mechanic damage in
akson optic nerve
Increase of TIO also induced ischemic of nerve
akson due to decreased blood flow in papil optic

Oblique illumination of the anterior chamber--The anterior chamber is illuminated by a beam of light
tangential. a shallow anterior chamber an angle that is
partially or completely closed
Slit lamp examination-- Gonioscopy
Measuring intraocular pressure--- Palpation,
Optic disk ophtalmoscopy --- increase in the size of
the optic cup and to pale discoloration of the optic disk
Visual field testing

Diferential Diagnosis
Acute Iritis
Acute Konjuctivitis

Pilokarpin 2% a drop/min in 5 min, after that
every 1 hour
Asetazolamid 500mg IV (TIO > 50mmHg) or
oral (TIO < 50mmHg)
alternative : mannitol 20% 1-2g/KgBB, gliserol
50% 1-1,5g/kgBB (KI: DM).

Surgical Indications
Medical therapy is insufficient.
The patient does not tolerate medical therapy.
The patient is not a suitable candidate for
medical therapy due to lack of compliance in
applying eyedrops.

Laser burns in the trabecular meshwork cause
tissue contraction that widens the intervening
spaces and improves outflowthrough the
trabecular meshwork.
Laser surgery in the angle of anterior chamber is
possible only if the angle is open.

Peripheral iridectomy
A limbal incision is made at 12 oclock under
topical anesthesia or general anesthesia,


Factors that increase resistance to pupillary outflowand predispose to

closure glaucoma