ACUTE GLAUCOMA

1. ACUTE GLAUCOMA ESSAM OSMAN ,FRCS ASSISTANT PROFESSOR,CONSULTANT DEPATMENT OF OPHTHALMOLOGY K.S.U.

2. GLAUCOMA EGS definition: progressive optic neuropathies, that have in common characteristic morphological changes at the optic nerve head and retinal fiber layer in the absence of other ocular disease or congenital anomalies. Progressive retinal ganglion cell death and visual field loss are associated with these changes.�

3. GLAUCOMA *A major cause of blindness. *Often A symptomatic; in early stage. *Damage is irreversible. *Effective treatment is available.

4. The Visual Pathway Let us recall the visual pathway. Light enters the eye via the refractive media, namely the cornea, anterior chamber, lens, and vitreous, and stimulates the retina posteriorly.Let us recall the visual pathway. Light enters the eye via the refractive media, namely the cornea, anterior chamber, lens, and vitreous, and stimulates the retina posteriorly.

5. The Visual Pathway *Phototransduction:By photoreceptors (rods and cones) *Image processing:By horizontal, bipolar, amacrine and RGCs *Output to optic nerve:Via RGCs andnerve fiber layer Light stimulates the photoreceptors, ie., the rods and cones. Through a series of other retinal nerve cells, the end result is that the RGC is stimulated. The RGC sends its axon, or fiber, in the nerve fiber layer to the optic disc and then down the optic nerve.Light stimulates the photoreceptors, ie., the rods and cones. Through a series of other retinal nerve cells, the end result is that the RGC is stimulated. The RGC sends its axon, or fiber, in the nerve fiber layer to the optic disc and then down the optic nerve.

6. The Visual Pathway From the optic nerve, about half of the fibers cross over at the chiasm to the opposite optic tract, and the other half remain on the same side. The fibers in the optic tract synapse in the lateral geniculate nucleus of the thalamus. Neurons in the lateral geniculate nucleus then project to the occipital lobe, to the primary visual cortex. From there, there is further processing with projections to other cells in the visual cortex and elsewhere, resulting in conscious visual perception. Now that we know how visual information is normally transmitted to the brain, what happens with a disease like glaucoma?From the optic nerve, about half of the fibers cross over at the chiasm to the opposite optic tract, and the other half remain on the same side. The fibers in the optic tract synapse in the lateral geniculate nucleus of the thalamus. Neurons in the lateral geniculate nucleus then project to the occipital lobe, to the primary visual cortex. From there, there is further processing with projections to other cells in the visual cortex and elsewhere, resulting in conscious visual perception. Now that we know how visual information is normally transmitted to the brain, what happens with a disease like glaucoma?

7. TYPES OF GLAUCOMA

8. ACUTE GLAUCOMA

9. Etiology *PRIMARY *SECONDARY

10. Primary angle closure glaucoma ANATOMIC FEATURES: SMALL CORNEAL DIAMETER SHALLOW ANTERIOR CHAMBER THICKER LENS SMALL RADIUS OF THE ANTERIOR LENS CURVATURE ANTERIOR LENS POSITION SHORT AXIAL LENGTH HYPEROPIC EYES

21. Secondary Angle Closure Glaucomas Mechanism Pulling & Pushing

22. Pushing Mechanism Pupillary block Tumors or cysts �Cil. Bod, chr.� Posterior swelling

23. Pushing Mechanism

24. Pushing Mechanism

25. Pushing Mechanism

26. Pulling Mechanism Membrane Inflammation Abnormal tissue

27. NVGNeovascular membrane developed in the surface of the iris and anglecauses:Diabetic retinopathyCentral retinal vein occlusionCarotid occlusive diseaseOcular ischemic syndromeCentral retinal artery occlusionRadiotherapy, RD surgery, uveal melanoma

28. NVG Management Admission to hospital Anti-glaucoma medication Full PRP When NVI&NVA disappear trabeculectomy

29. Importance of gonioscopy

30. Video gonioscopy

31. conclusion Acute glaucoma is not always primary Gonioscopy is necessary in all patient Laser iridotomy prophylactic can prevent any attack. Thank you