Escolar Documentos
Profissional Documentos
Cultura Documentos
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not a single disease
group of diseases some common characteristics
hallmarks:
optic nerve head changes
typical, often progressive
visual field loss
IOP??
common end point irreversible loss of visual function
blindness
no typical glaucoma patient OR single best glaucoma
treatment
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Advanced age
Gender
Race (Caucasian, Asian)
IOP
Refractive error (Myopia, Hyperopia)
Central corneal thickness
Family history
Underlying disease (diabetes, cardiovascular disease, retinal
vein occlusion, migraine)
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(Choplin NT & Lundy DC, 2007. Atlas of Glaucoma. 2nd ed)
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(Choplin NT & Lundy DC, 2007. Atlas of Glaucoma. 2nd ed)
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By mechanism
By age of onset
By IOP
By stage of disease
Based upon ICD 9
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(Choplin NT & Lundy DC, 2007. Atlas of Glaucoma. 2nd ed)
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time of day
heartbeat
respiration
exercise
fluid intake
systemic medications
topical medications
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Generalized depression
Paracentral scotoma
Arcuate or Bjerrum scotoma
Nasal step
Altitudinal defect
Temporal wedge
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Chronic, slowly progressive
Painless
Bilateral, quite asymmetric
Pretrabecular (membrane overgrowth)
Trabecular
Posttrabecular
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Race
Ocular biometrics small, crowded anterior segments, short AXL
Age
Gender
Family history
Refraction
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Medical management
Surgical
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topical ocular hypotensive agents
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(Choplin NT & Lundy DC, 2007. Atlas of Glaucoma. 2nd ed)
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Open -Angle Glaucoma Other Procedures to Lower lOP
Laser Trabeculoplasty Aqueous Shunt Implantation
Incisional Surgery Ciliary Body Ablation Procedures
Full-Thickness Sclerectomy Cyclodialysis
Combined Cataract and Filtering Nonpenetrating Glaucoma Surgery
Surgery Primary Congenital Glaucoma
Angle-Closure Glaucoma Goniotomy and Trabeculotomy
Laser Iridectomy
Laser Gonioplasty or Peripheral
Iridoplasty
Incisional Surgery
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Advanced age 40 yo
Positive family history
Measure IOP
Careful examination of ONH
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Pain
Blurred vision
Colored halos around lights
Frontal headache
Nausea
Vomiting
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High IOP
Iris bombe
Middilated, sluggish, and irregularly shaped pupil
Corneal epithelial edema
Congested episcleral and conjunctival blood vessels
Shallow anterior chamber
A mild amount of aqueous flare and cells
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History: risk factors?
Examination
Measure IOP
Gonioscopy both anterior chamber angle
Examination of fundus
Bscan US if secondary angle closure glaucoma is suspected
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Urgent IOP reduction:
Osmotics agents, oral or i.v
CAI e.g. acetazolamide 250 500 mg i.v or 2x250 mg tablets
p.o in one dose
Topical blocker
Topical steroid
Recheck IOP and VA in 1 hour
Definitive treatment
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Glaucoma is sight threatening
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