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    Glaucoma STG 2021

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    daniel mitiku

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    Glaucoma STG 2021

    Uploaded by

    daniel mitiku
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    Download as pptx, pdf, or txt
    10 views11 pages

    Glaucoma STG 2021

    Uploaded by

    daniel mitiku

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    You are on page 1of 11

    GLAUCOMA MANAGEMENT

    Overview
     It is a group of diseases characterized by progressive optic neuropathy
    and visual field loss
     It is a major blinding disease worldwide and the leading cause of
    irreversible blindness
     Classified based of etiology, age of onset, mechanism, chronicity, and
    more
     Usually bilateral, but may be unilateral or asymmetrical (usually
    secondary)
    Risk factor

     Primary risk factor is elevated IOP (> 21 mm Hg), “normal IOP” doesn‘t
    rule out glaucoma
     Others risks are advanced age, positive family history, race, refractive
    error, eye surgery or injury, steroid use, inflammation, refractive error.

     Primary open angle and Pseudo-exfoliative glaucoma are the commonest


    types in Ethiopia
    Chronic Glaucoma: Clinical features
    Symptoms
     Mostly asymptomatic (“sight thief”)
     History of gradual loss of vision in the affected eye or loss of visual

    field
    Signs
     Cupping of optic disc on fundoscopy and /or elevated IOP
     RAPD (useful to detect an eye with advanced glaucoma)
     Digital palpation to compare both eyes
    Investigations and diagnosis:

     Tonometry measures intraocular pressure (IOP)


     Visual field test (confrontation, FDT, standard perimetry)
     Ophthalmoscopy fundus examination
    Treatment: Goal

     Early detection, control IOP and preserve vision


     Maintain the IOP to the safe level that does not cause damage
     Halt progressive optic nerve head damage and visual field loss
     Decrease the medication side effects
    Non-pharmacological treatment

     Surgery – Trabeculectomy, Tube-shunt implant


     Laser treatment
    Pharmacological treatment
    Chronic open angle glaucoma
     Beta adrenergic antagonist

     Timolol 0.25% or 0.5% eye drops, instill 1 drop BID OR


     Betaxolol 0.5% eye drops, instill 1 drop BID

     Prostaglandin analogues:

     Latanoprost 0.005% eye drops, instill 1 drop daily if target IOP not reached
     NB. Currently prostaglandin analogue eye drops are the first line, if available
     Also, can be used alone in cases of intolerance and contraindications to

    betablockers
     Alternative: Travoprost 0.004%
    Cont’d
    Adrenergic Agonists
     Brimonidine 2% eye drops, instill 1 drop BID  Apraclonidine eye drop,

    instill BID or TID


     NB. Use as second line if patient has allergic reaction to prostaglandin

    analogue, in place of prostaglandin analogue and/or in combination with


    ß-blocker. Avoid use in children less than 2 years.
     Combination drugs can be used if the patient has poor response.

     Combinations should be from different therapeutic classes.


    Para sympathomimetic:

     Pilocarpine, 2 and 4%, eye drops, instill 1 drop QID, drug of choice in
    pigmentary glaucoma
     NB. Avoid use in young patient (except in pigmentary Glaucoma),
    uveitic glaucoma, and primary open angle glaucoma (POAG) with high
    myopia
    Carbonic anhydrase inhibitors:
     Acetazolamide 125 to 250mg, BID to QID or Methazolamide 50 to 100mg,
    BID to TID
     Dorzolamide 2% eye drop 1 drop BID or TID or Brinzolamide 1% eye drop, 1
    drop BID to TID
     NB: The oral preparations only used in cases of very high IOP used for short
    period, due to side effects
     Referral: Refer all cases of glaucoma and/or glaucoma suspect to an
    ophthalmologist

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