ACUTE GLAUCOMA

ZALDI
FAKULTAS KEDOKTERAN
UNIVERSITAS MUHAMMADIYAH SUMATERA UTARA
MEDAN
2014
ZALDI

ACUTE GLAUCOMA

9/2/16 04:42:03 PM

Dengan menyebut nama Allah

Yang Maha Pengasih Maha
Penyayang.

ZALDI

ACUTE GLAUCOMA

9/2/16 04:42:04 PM

ZALDI

ACUTE GLAUCOMA

9/2/16 04:42:04 PM

I. TUJUAN INSTRUKSIONAL UMUM

4

Setelah Proses Belajar Mengajar mahasiswa

mampu menegakkan diagnosa glaukoma
akut dengan melakukan anamnese dan
pemeriksaan sederhana yang akan dipelajari
selama masa perkuliahan dengan baik dan
benar .
ZALDI

ACUTE GLAUCOMA

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II. TUJUAN INSTRUKSIONAL KHUSUS

5

Setelah Proses Belajar Mengajar mahasiswa

mampu mengetahui tanda dan gejala , faktor
resiko, prinsip pengobatan, komplikasi, dan
mengkonsulkan secara garis besar dengan
baik dan benar kasus-kasus glaukoma akut
sesuai dengan kompetensinya
ZALDI

ACUTE GLAUCOMA

9/2/16 04:42:04 PM

DEFINITION
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ACUTE GLAUCOMA
(Acute angle closure)
occurs when sufficient
iris bomb develops to
cause occlusion of the
anterior chamber angle
by the peripheral iris.

ZALDI

ACUTE GLAUCOMA

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ACUTE ANGLE CLOSURE

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DEFINITION :
Occurs
when sufficient iris bomb
develops to cause occlusion of the
anterior
chamber
angle
by
the
peripheral iris.
This blocks aqueous outflow, and the
intraocular
pressure
rises
rapidly,
causing severe pain, redness, and
blurring of vision.
ACUTE GLAUCOMA

ZALDI

DEFINITION
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Angle-closure glaucoma (ACG) is a

condition in which the iris is apposed to
the trabecular meshwork at the angle of
the anterior chamber of the eye.

ACUTE GLAUCOMA

ZALDI

CLASSIFICATION
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ZALDI

ACUTE GLAUCOMA

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AQUEOUS HUMOR OUTFLOW

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ZALDI

ACUTE GLAUCOMA

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AQUOS HUMOR OUTFLOW

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ZALDI

ACUTE GLAUCOMA

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ETIOLOGY
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HYPEROPIC EYE AND CRYSTALLINE LENS

ENLARGEMENT

SPONTANEOUSLY PUPILLARY DILATION

( when the level of illumination is reduced )

DRUGS ( anticholinergic or sympathomimetic eg,

atropine , antidepressants, nebulized
bronchodilators, nasal decongestants, or
tocolytics).
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ACUTE GLAUCOMA

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HYPEROPIC EYE AND CRYSTALLINE LENS ENLARGEMENT

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ZALDI

ACUTE GLAUCOMA

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ACUTE ANGLE CLOSURE

= ACUTE GLAUCOMA
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ACUTE GLAUCOMA

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CLINICAL FINDINGS
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SUDDEN ONSET OF VISUAL

LOSS
PHOTOPHOBIA
HALOS
NAUSEA AND VOMITING
INCREASED INTRAOCULAR
PRESSURE
STEAMY CORNEA
CILIARY INJECTION
SHALLOW ANTERIOR
CHAMBER
MODERATELY DILATED PUPIL
ZALDI

ACUTE GLAUCOMA

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DIFFERENTIAL DIAGNOSIS ( 1 )
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1. ACUTE IRITIS
o more photophobia ,
o IOP not elevated
o pupil is constricted or
irregular in shape
o cornea not
edematous.
o flare and cells in AC
o deep ciliary injection.
ZALDI

ACUTE GLAUCOMA

9/2/16 04:42:04 PM

DIFFERENTIAL DIAGNOSIS ( 2 )
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2. ACUTE CONJUNCTIVITIS
bilateral
cornea is clear.
no photophobia ,
no visual loss
no ciliary injection
discharge
pupillary responses
IOP normal
ZALDI

ACUTE GLAUCOMA

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COMPLICATIONS
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1. ANTERIOR SYNECHIAE ( the peripheral

iris may adhere to the trabecular
meshwork )
2. IRREVERSIBLE OCCLUSION AC
3. OPTIC NEUROPATHY
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ACUTE GLAUCOMA

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OPTIC NEUROPATHY
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ZALDI

ACUTE GLAUCOMA

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TREATMENT ( MEDICAL )
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Acute Glaucoma is an ophthalmic emergency!

REDUCING IOP :
1.
2.
3.
4.

Intravenous and oral acetazolamide

Topical agents : beta-blockers and apraclonidine,
Hyperosmotic agents : mannitol 20% , glicerol 50 %
Pilocarpine 2% , 4% ( by which time reduction of iris
ischemia and lowering of intraocular pressure allow
the sphincter pupillae to respond to the drug.

TOPICAL STEROIDS to reduce secondary intraocular

inflammation ( controversial )

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ACUTE GLAUCOMA

9/2/16 04:42:04 PM

TREATMENT ( SURGERY )
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1. LASER PERIPHERAL IRIDOTOMY ( YAG Laser)

( to form a permanent connection between
the anterior and posterior chambers, thus
preventing recurrence of iris bomb )
2. TRABECULECTOMY & PERIPHERAL
IRIDECTOMY
3. PROPHYLACTIC LASER IRIDOTOMY (fellow eye)
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ACUTE GLAUCOMA

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PERIPHERAL IRIDECTOMY
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ZALDI

ACUTE GLAUCOMA

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TRABECULECTOMY
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ZALDI

ACUTE GLAUCOMA

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GLAUCOMA
GLAUCOMA

Optic Neuropathy

VF loss

RGC death
Mechanical
damage

Neuroprotection
Neutrophin
withdrawal

Stop
axoplasmic
flow

IOP

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IOP

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Retina

ISCHEMI
A ONH
Vascular dysregulation

PP

Sclerotic vascular wall

vasospasm

BP
OBF

ACUTE GLAUCOMA

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REFERENCES
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American Academy of Ophthalmology, Glaucoma,

Section 10, 2011-2012
American Academy of Ophthalmology, External
Disease and Cornea, Section 8, 2011-2012
Khurana AK, Comprehensive Ophthalmology, Fourth
Edition , New Delhi, New Age Internasional (p)
Limited Publisher, 2007.
Vaughan & Asbury's :
General Ophthalmology
17th Edition , Mc Graw- Hills Companies , May 2007

ZALDI

ACUTE GLAUCOMA

9/2/16 04:42:05 PM

Segala puji bagi Allah, Tuhan semesta

alam.

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ZALDI

ACUTE GLAUCOMA

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27

THANKS YOU

ZALDI

ACUTE GLAUCOMA

9/2/16 04:42:05 PM