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1 ACUTE GLAUCOMA

ZALDI
FAKULTAS KEDOKTERAN
UNIVERSITAS MUHAMMADIYAH SUMATERA UTARA
MEDAN
2014

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Dengan menyebut nama Allah
Yang Maha Pengasih Maha Penyayang.

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I. TUJUAN INSTRUKSIONAL UMUM
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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 .

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II. TUJUAN INSTRUKSIONAL KHUSUS
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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

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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.

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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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AQUEOUS HUMOR OUTFLOW
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AQUOS HUMOR OUTFLOW
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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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HYPEROPIC EYE AND CRYSTALLINE LENS ENLARGEMENT

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ACUTE ANGLE CLOSURE
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= ACUTE GLAUCOMA
IRIS BOMBE

OCLUSION AC ANGLE

BLOCKS AQUEOUS
OUTFLOW

INTRAOCULAR PRESSURE

ACUTE GLAUCOMA ZALDI


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

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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.

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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

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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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OPTIC NEUROPATHY
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TREATMENT ( MEDICAL )
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Acute Glaucoma is an ophthalmic emergency!

REDUCING IOP :
1. Intravenous and oral acetazolamide
2. Topical agents : beta-blockers and apraclonidine,
3. Hyperosmotic agents : mannitol 20% , glicerol 50 %
4. 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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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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PERIPHERAL IRIDECTOMY
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TRABECULECTOMY
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GLAUCOMA Optic Neuropathy VF loss

RGC death
Mechanical Neuroprotection
damage
Neutrophin Retina
withdrawal ISCHEMIA
ONH
Stop
axoplasmic
flow Vascular dysregulation

Sclerotic vascular wall


IOP PP BP vasospasm

IOP OBF
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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

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Segala puji bagi Allah, Tuhan semesta alam.

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THANKS YOU

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