DIAGNOSIS OF GLAUCOMA

SUE TING, LIM

Raised IOPGlaucomatous Optic Nerve Head

changesVisual Field DefectsOPEN angle of anterior chamber

Primary Open Angle Glaucoma

Primary Closed Angle Glaucoma

Raised IOPGlaucomatous Optic Nerve Head

changesVisual Field DefectsCLOSED angle of anterior

chamber

Normotensive or Low Tension Glaucoma (NTG / LTG)

a. Cupping of discb. Visual Field defectsc. Normal or Low IOP

Ocular Hypertension

Constantly raised IOPWITHOUT associated glaucomatous

damage

Secondary Glaucoma

Rise of IOP Associated with primary ocular or

systemic disease Types:1. Secondary Open Angle Glaucoma2. Secondary Angle Closure Glaucoma

PRESENTATION OF PATIENT

OPEN ANGLE GLAUCOMA ANGLE CLOSURE GLAUCOMA

Insidious and asymptomatic Severe pain(Vth nerve)

Headache and Eyeache Nausea, Vomiting asso. With pain

Scotoma Redness

Frequent changes in presbyopic lens

Lacrimation

Delayed Dark Adaptation Photophobia

Loss of vision and blindness H/o intermittent attacks of subacute ACG

CLINICAL SIGNS

OPEN ANGLE GLAUCOMA:

Sluggish pupillary reflex Diurnal variation of IOP (>8mmHg) Provocative Tests Persistently raised IOP Optic disc changes Visual field defects

CLINICAL SIGNS

ANGLE CLOSURE GLAUCOMA:

Eclipse Sign Provocative tests(PACG suspect) Closed angle on Gonioscopy Acute RED eye Semidilated, vertically oval and fixed

pupil Raised IOP Optic disc hyperaemic and oedematous

ANGLE CLOSURE GLAUCOMA

DIAGNOSTIC CRITERIAS

DIAGNOSTIC CRITERIA DIAGNOSTIC TESTS

1. INTRAOCULAR TENSION TONOMETRY

2. OPTIC NERVE HEAD CHANGES

OPHTHALMOSCOPY

3. VISUAL FIELD DEFECTS PERIMETRY

4. ANGLE OF ANT. CHAMBER GONIOSCOPY

TONOMETRY

DIGITAL TONOMETRY INDENTATION TONOMETRY

- Shiotz Tonometer APPLANATION TONOMETRY

- Goldmann Tonometer- Perkin’s Tonometer- Pneumatic Tonometer- Pulse Air Tonometer- Tono-Pen

TONOMETRY FINDINGS

OCULAR NORMOTENSION: 10-21 mmHg

OCULAR HYPERTENSION OCULAR HYPOTENSION

OPTIC NERVE HEAD CHANGES

Early Changes Vertically oval cup Asymmetry of C:D ratio between two

eyes(>0.2) Enlarged C:D Ratio (>0.5) Pallor Areas

OPTIC NERVE HEAD CHANGES

Advanced Changes: Notch/Thinning of neuroretinal rim Pallor of neuroretinal rim Superficial disc haemorrhages Cupping of disc Bayonetting Sign Lamellar Dot Sign

OPTIC NERVE HEAD CHANGES

Glaucomatous optic atrophy:

Neural disc is destroyed Optic nerve head appears white and

deeply excavated

Increased C:D Ratio

Thinning of neuroretinal rim

Cupping of discs and Bayonetting sign

Bayonetting Sign

PERIMETRY

Kinetic Perimetrya. Confrontation methodb. Lister’s perimetry Static Perimetrya. Automated perimetry-Humphrey field analyser-Octopus

VISUAL FIELD DEFECTS

Isopter Contraction Relative paracentral scotomas Seidel Scotoma Arcuate Scotoma/ Bjerrum’s Scotoma Double arcuate/Ring scotoma Roenne’s Nasal Step Temporal Island and Tubular vision Total lost of vision

GONIOSCOPY

Open Angle Closed Angle

PACHYMETRY

Measure the thickness  Corneal thickness has the potential

to influence eye pressure readings

ADVANCES IN DIAGNOSIS

Optical Coherence Tomography Scanning Laser Polarimetry Confocal Scanning laser topography

(CSLT)

Heidelberg Retinal Tomograph

SLP

Optic Coherence Tomography