ACUTE CONGESTIVE GLAUCOMA

DR. TENRI SANNA DEVI SP.M

BAGIAN ILMU KESEHATAN MATA

FAKULTAS KEDOKTERAN
UNIVERSITAS HASANUDDIN
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DEFINITION
GLAUCOMA IS AN OPTIC NEUROPATHY WITH
CHARACTERISTIC APPEARANCE OF OPTIC
DISC AND SPECIFIC PATTERN OF VISUAL FIELD
DEFECTS THAT IS ASSOCIATED FREQUENTLY
BUT NOT INVARIABLY WITH RAISED IOP
ACUTE CONGESTIVE GLAUCOMA
IT IS A SUDDENLY RAISED INTRAOCULAR
PRESSURE AND DECREASES VISUAL
FUNCTION WITH CONGESTION OF THE
EYE

TWO TYPE
- PRIMARY (UNKNOWN CAUSED)
- SECONDARY (HYPHAEMIA, LENS DISLO-
CATION, DM, ETC.)
AQUEOUS HUMOUR
PRODUCTION
ACTIVE SECRETION FROM NON-PIGMENTED EPITHELLIUM OF THE
CILIARY BODY AS RESULT OF A METABOLIC PROCESS ( Na+/K+
ATPase PUMP, CARBONIC ANHYDRASE)
OUTFLOW
TRABECULAR MESHWORK :
- UVEAL MESHWORK
- CORNEOSCLERAL MESHWORK
- ENDOTHELIAL (JUXTACANALICULAR) MESHWORK
SCHLEMM CANAL, CONNECT IN/DIRECTLY EPISCLERAL VEINS
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ACUT CONGESTIVE GLAUCOMA , PERFORM FROM

A. PRIMARY GLAUCOMA
STAGE 3 OF THE PRIMARY ANGLE CLOSURE GLAUCOMA.
= PRIMARY ANGLE-CLOSURE GLAUCOMA, 6 CLINICAL STAGES:
A. LATENT ANGLE-CLOSURE GLAUCOMA
B. SUBACUTE (INTERMITTEN) ANGLE-CLOSURE GLAUCOMA
C. ACUTE CONGESTIVE ANGLE-CLOSURE GLC
D. POSTCONGESTIVE ANGLE-CLOSURE GLAUCOMA
E. CHRONIC ANGLE-CLOSURE GLAUCOMA
F. ABSOLUTE ANGLE-CLOSURE GLAUCOMA
B. SECONDARY GLAUCOMA
1. IRIDICYCLITIS (IRIS BOMBANS) = INFLAMATORY
GLAUCOMA
2. BLUNT INJURY :
1- 12 HOURS AFTER INJURY
A. HIPHAEMIA TRAUMATIC
B. LENS DISLOCATION (TRAUMATIC)
3-5 MONTHS AFTER INJURY
A. ANGLE RECESS GLAUCOMA
B. GHOST CELL GLAUCOMA
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3. HYPERMATURE CATARACT
4. AFTER INTRAOCULER SURGERY
= RETINAL BUCKLING, SILICONE OIL
= CATARACT EXTRACTION
5. RUBEOSIS IRIDIS
= DM
= CRVO
6. INTRAOCULAR TUMORS
= RETINOBLASTOMA
= MULTIPLE MYELOMA
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1.ACUTE CONGESTIVE ANGLE-CLOSURE

GLAUCOMA (PRIMAY GLAUCOMA)
This is a sight –threatening emergency.
CLINICAL FEATURE
- Symptoms : + rapidly progressive unilateral visual loss
+ periocular pain & congestion
+ nausea & vomiting
- Slit lamp biomicroscopy
+ injection the limbal & conjunctival blood vessels
+ corneal oedema
+ peripheral iridocorneal contact
+ pupil is fixed semi-dilated, vertically oval
+ IOP is 50-100 mmHg
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- Gonioscopy, perform until the corneal oedema resolved by topical

glicerine or hypertonic saline ointment , shows complete periphe-
ral iridocorneal contact (Shaffer grade 0)
- Ophthalmoscopy, optic disc oedema & hyperaemia

IMMEDIATE TREATMENT
- Acetasolamide 500 mg/IV, 500 mg orally
-Topical therapy : + pilocarpine 2 %
+ beta blocker (timolol maleat 0,5 %)
- Glyserol 50 % (1g/Kg bw) orally or 20% mannitol IV
- Analgesia & anti-emetics
- YAG laser iridotomy : effective in relatively mild cases
-Trabeculectomy
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2. ACUT SECONDARY GLAUCOMA
 ANAMNESIS : IMPORTANT (INJURY, AFTER
OPERATION, METABOLIC DISEASES ETC)
 CLINICAL FEATURE : SYMPTOMS LIKES OF
THE ACUT PRIMARY ANGLE CLOSURE
GLAUCOMA. SIGN BY BIOMICROSCOPE CAN
BE OBSERVED THE CAUSED OF THE
GLAUCOMA AT THE ANTERIOR CHAMBER
(IRIS NEO-VASCULARISATION, HYPHAEMIA,
HYPO-PYON, LENS MATERIAL, VISCO-ELASTIC
MATERIAL ETC)
 MANAGEMENT :
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1. IRIS BOMBANS : ATROPIN ED, STEROID,

YAG LASER IRIDOTOMY
2. HYPHAEMIA : PARACENTESIS
3. HYPERMATURE CATARACT : LENS
EXTRACTION
4. LENS DISLOCATION : LENS EXTRACTION
5. EVACUATION : LENS/ VISCO MATERIALS
6. TRABECULECTOMY/ SHUNT (AHMED
VALVE IMPLANT)
7. ENUCLEATION
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