00:01
So overall,
for open-angle Glaucoma and
normal-pressure glaucoma
signs and symptoms,
it's usually asymptomatic,
it's not painful
and most people walking around
glaucoma don't know that they have it.
00:14
In fact,
that's why we have to do
a very thorough eye
exam and screen for it.
00:20
So when you go for your
ophthalmologic exam,
they'll puff their little
puffer in your eyeball,
and they will get a
sense of the pressure.
00:28
It's an important
part of the exam.
00:30
And there are other
ways that we can do this
called tonometry that
we'll talk about shortly.
00:36
As we get progressive
compression of the optic nerve
at the back of the eye,
with all of these pressures,
kind of differentials being
eventually translocated to
the posterior
portion of the eye,
you'll get a gradual loss
of peripheral vision.
00:48
And then late in the process,
you'll get loss of central vision.
00:53
And if it's untreated,
you will go blind.
00:56
So that's open-angle glaucoma.
00:59
Closed-angle glaucoma.
01:02
Chronic closed-angle
glaucoma can be a very
slow motion way of
developing glaucoma,
so that you have
much less symptomatology.
01:13
So, chronic closed-angle glaucoma,
as indicated here in the title
will overall be less severe and
may be completely asymptomatic.
01:23
But again, you'll have gradual
loss of peripheral vision
and then a decrease
in central vision.
01:27
And eventually you can go blind.
01:29
Conversely,
acute closed-angle glaucoma
is an ophthalmologic emergency.
01:35
And in this setting,
we have now acutely
change the geometry for
a variety of reasons,
things that we talked
about previously.
01:42
And there will be an abrupt,
acute increase in
intraocular pressure
that can be manifested by a
number of symptoms and signs.
01:52
So that's what's shown here.
01:53
In acute closed-angle
glaucoma you can have in fact,
relatively severe eye pain,
you can have headache.
01:59
Photophobia, because in fact,
you're not getting the normal relaxation,
the mydriasis of the pupil, so that you
have too much light getting through.
02:10
The vision may be blurred,
because we have in fact increased pressure.
02:15
There will be halos
around bright lights
and because of the increased
intraocular pressure,
in fact that can be acutely felt
and manifested as
nausea and vomiting.
02:24
So it can be quite severe.
02:26
The signs are those that you see
right here, it'd be a red eye.
02:30
So there is conjunctivitis
associated with this
as we are compromising the outflow
of blood out of the conjunctiva.
02:39
So the vessels look dilated
and the cornea can look steamy because
of then increases in edema fluid
that's actually getting
into our cornea.
02:49
The pupil is mid dilated
and nonreactive light.
02:52
This is part of the photophobia
and there will be an
absence of accommodation
in the light reflex
because the various
sphincter muscles of the iris
will not function appropriately.
03:04
This is an ophthalmologic
emergency.
03:08
So how do we diagnose glaucoma?
One of the major elements,
the major tools that we use
are devices that will measure
the intraocular pressure,
the tonometry devices,
and couple are shown here.
03:22
That's not enough though,
because you can have normal pressure
glaucoma as we talked about, and you
may have completely normal pressures
as measured with those devices.
03:32
So you need to evaluate
the rest of the eye.
03:36
In terms of deciding whether you have
closed-angle or open-angle glaucoma,
looking at the anterior chamber
angle is an important element.
03:43
And that's the visualization
as is shown here.
03:47
You also want to look
for optic disc changes.
03:51
As the pressures change,
we will see on fundoscopic exam
differences in the appearance
of the back of the eye.
03:59
And that's shown on
this slide were normal
around the optic disc,
you can see the vessels,
you can see a normal area
of power where we don't have
such a high density
of microvasculature
but you can see that
there are vessels there.
04:16
In glaucoma as we get
progressive nerve atrophy
and compressed the vessels going
in and out at the optic disc,
you'll see this large
area of yellow power
and so that is a real sign
of optic disc atrophy.
04:31
And then finally,
you will assess for visual field changes,
cuts in the visual field and they will
be all over the place from complete
cut out to little tiny
dots scotoma throughout
depending on how the nerves are being
compressed at the back of the eye
as they exit through
the optic desk.
04:54
The management overall
for glaucoma focuses
primarily on lowering
intraocular pressure.
05:00
Even in normal pressure,
glaucoma, we still may want to try
to reduce the intraocular pressure.
05:06
And we'll use either
pharmacologic means
remember we can modify
parasympathetic and sympathetic tone,
which will affect
intraocular pressure
or we can use surgical methods
if the sewer grate is blocked,
we can open that up.
05:20
So there are a variety
of things that we can do.
05:22
But we do need to intervene so that the
patient doesn't go completely blind.
05:27
And with that,
we finished our discussion on glaucoma.