Trabecular network has increased resistance so drainage is slower.
Causes/Factors
- Increasing age
- Family history
- Black ethnic origin
- Myopia (nearsightedness)
Clinical Features
Glaucoma affects the peripheral vision first, resulting in a gradual onset of peripheral vision loss (tunnel vision). It can also cause:
- Fluctuating pain
- Headaches
- Blurred vision
- Halos around lights, particularly at night
Investigations
Both apply pressure to cornea and measure response/resistance
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Non-contact tonometry (less accurate)
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Goldmann applanation tonometry (gold standard)
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Slit lamp assessment for increased cup-disk ratio (eye anatomy)
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Visual field assessment for peripheral vision loss
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Gonioscopy to assess angle between iris and cornea
Management
Treatment started at an intraocular pressure of 24mmHg or above
Medications:
- Prostaglandin analgue eye drops (latanoprost) first line - increase uveoscleral outflow
- Beta-blockers (timolol) reduce the production of aqueous humour
- Carbonic anhyrase inhibitors (dorzolamide) reduce the production…
- Sympathomimetics (brimonidine) does both
Surgical: 360 selective laser trabeculoplasty
- Laser directed at the trabecular meshwork, improving drainage
- A second procedure may be needed at a later date
Complications/red Flags
- Irreversible loss of vision (partial or complete) is the main complication of untreated glaucoma.
- However angle closure glaucoma is considerably more likely than open angle glaucoma to cause blindness