Glaucoma

Definition of Glaucoma
• Glaucoma is an optic disc neuropathy which is characterized
by:
– High intra ocular pressure (IOP) > 21 mmHg,
– Optic nerve fibers death  optic disc damage,
– Progressive visual field defect,
 Glaucoma is the most common cause of blindness
worldwide and is the second major cause of blindness
in Indonesia

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 Prevalence

Glaucoma is a common cause of irreversible blindness with

increasing prevalence. The incidence of glaucoma in various
parts in this country varies from 0,4% to 1,6%. According to
World Health Organization (WHO), glaucoma is the third
most common cause of blindness in the world. It is estimated
that the number of people living with glaucoma worldwide
will grow from 60.5 million in 2010 to 79.6 million in 2020.
Glaucoma is most commonly found among women (59%) and
Asian races (49%).

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 Classification of the glaucomas
• According to:
– Outflow impairment: open angle and angle
closure glaucoma,
– contributing factors to IOP : primary and
secondary glaucoma,
– Age: congenital, infantile, juvenile, adult.

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 Primary glaucomas

• High IOP is not associated with any ocular

disorder
– Open angle
– Angle closure
– Congenital (developmental)

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Secondary glaucoma

• Aqueous outflow alters by ocular / non ocular disorders 

IOP » :
– Secondary open angle glaucoma: pretrabecular,
trabecular and post-trabecular,
– Secondary angle closure glaucoma caused by
apposition between the peripheral iris and trabeculum,
– Pathogenesis: anterior forces / posterior forces

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 Incidence

• Primary glaucoma is:

– hereditary
– female > male
– especially at age > 40 years

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 Incidence

• Congenital glaucoma  since in the intrauterine

• Infantile glaucoma  after birth until 2 years
• Juvenile glaucoma  age 10 - 15 years
• Secondary glaucoma: glaucoma as a complication
from other eye disease

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 Risk Factors
• Family History
• Older age
• Diabetes mellitus
• Cardiovascular disease
• Migraine syndromes
• Myopia
• Eye Trauma
• Prolonged use of topical or systemic corticosteroids
 Caused by….

Increase in IOP that surrounds the eye ---

-imbalance of aqueous humor
production and drainage
 Signs and Symptoms
• Cloudy or haloed vision
• Nausea or headaches
• Light sensitivity (photophobia)
• Excessive blinking (blepharospasm)
• Crossed or out-turned eyes (strabismus)
• One eye becoming larger than the other
• Excessive tearing (epiphora)
• Decreased vision (amblyopia)
Precipitating Factors: Predisposing Factors:
- DM, CVD
- Migraine
- Family history
- Age
P
- Myopia
- Eye trauma
- Race
- Gender
A
- Prolonged use of
steroids T
H
O
Changes in the aqueous
humor flow system
P
Y
*Impaired blood flow in
S
the optic nerve I
*Increase IOP
O
Atrophy of the Optic
L
Nerve O
G
Progressive loss of vision Y
 Diagnostic Tests

• Tonometry
• Pachymetry
• Gonioscopy
• Ophthalmoscopy
• Visual Field Screening
Ophthalmoscopy
Gonioscopy
Tonometry
Pachymetry
 Medical Management…….

• Prevention of optic nerve

damage
• By: Pharmacotherapy and
Surgery
 Pharmacologic Treatment
• Parasympathomimetic agents
• Sympathomimetic agents
• Beta-adrenergic blocking agents
• Hyperosmotic agents
• Carbonic anhydrase inhibitors
• Alpha2-adrenoreceptor agonists
 Surgery
• Laser iridotomy
• Laser trabeculoplasty
• Trabeculectomy
• Viscocanalostomy
 Glaucoma Prognosis
• Irreversible blindness
• Acute symptoms are manageable
to preserve vision
• Early diagnosis and treatment is
the key
 COMPLICATIONS

When treatment is delayed, the peripheral iris

may be attached to the trabecular tissue,
resulting in an irreversible blockage of the
anterior camera angle requiring surgical action
to correct it. Optic nerve damage is common.

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 Prevention

You may not be able to prevent glaucoma.

But self-care can help you detect it early, limit

vision loss or slow its progress.
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 Know your
regular eye
family's eye
exams
health history

Prevention

Protect Your
Exercise
Eyes
Thank you
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