Z A L D I FAKULTAS KEDOKTERAN UNIVERSITAS MUHAMMADIYAH SUMATERA UTARA MEDAN 2013 ACUTE GLAUCOMA 06/05/2013 07:18 1 Z A L D I ACUTE GLAUCOMA
Z A L D I
FAKULTAS KEDOKTERAN
UNIVERSITAS MUHAMMADIYAH SUMATERA UTARA
MEDAN
2013
ACUTE GLAUCOMA
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Z A L D I ACUTE GLAUCOMA
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Dengan menyebut nama Allah
Yang Maha Pengasih Maha Penyayang.
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I. TUJUAN INSTRUKSIONAL UMUM
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Setelah Proses Belajar Mengajar mahasiswa
mampu menegakkan diagnosa glaukoma
akut dengan melakukan anamnese dan
pemeriksaan sederhana yang akan dipelajari
selama masa perkuliahan dengan baik dan
benar .
II. TUJUAN INSTRUKSIONAL KHUSUS
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Setelah Proses Belajar Mengajar mahasiswa
mampu mengetahui tanda dan gejala , faktor
resiko, prinsip pengobatan, komplikasi, dan
mengkonsulkan secara garis besar dengan
baik dan benar kasus-kasus glaukoma akut
sesuai dengan kompetensinya
DEFINITION
ACUTE GLAUCOMA
(“Acute angle closure”)
occurs when sufficient
iris bombé develops to
cause occlusion of the
anterior chamber angle
by the peripheral iris.
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Z A L D I ACUTE GLAUCOMA
CLASSIFICATION
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AQUEOUS HUMOR OUTFLOW
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AQUOS HUMOR OUTFLOW
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ETIOLOGY
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HYPEROPIC EYE AND CRYSTALLINE LENS ENLARGEMENT
SPONTANEOUSLY PUPILLARY DILATION
( when the level of illumination is reduced )
DRUGS ( anticholinergic or sympathomimeticeg, atropine , antidepressants, nebulizedbronchodilators, nasal decongestants, or tocolytics).
HYPEROPIC EYE AND CRYSTALLINE LENS ENLARGEMENT
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CLINICAL FINDINGS
SUDDEN ONSET OF VISUAL LOSS
PHOTOPHOBIA
HALOS
NAUSEA AND VOMITING
INCREASED INTRAOCULAR PRESSURE
STEAMY CORNEA
CILIARY INJECTION
SHALLOW ANTERIOR CHAMBER
MODERATELY DILATED PUPIL
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Z A L D I ACUTE GLAUCOMA
DIFFERENTIAL DIAGNOSIS ( 1 )
1. ACUTE IRITIS
o more photophobia ,
o IOP not elevated
o pupil is constricted or
irregular in shape
o cornea not edematous.
o flare and cells in AC
o deep ciliary injection.
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Z A L D I ACUTE GLAUCOMA
DIFFERENTIAL DIAGNOSIS ( 2 )
2. ACUTE CONJUNCTIVITIS
bilateral
cornea is clear.
no photophobia ,
no visual loss
no ciliary injection
discharge
pupillary responses
IOP normal
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Z A L D I ACUTE GLAUCOMA
COMPLICATIONS
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1. ANTERIOR SYNECHIAE ( the peripheral
iris may adhere to the trabecular
meshwork )
2. IRREVERSIBLE OCCLUSION AC
3. OPTIC NEUROPATHY
OPTIC NEUROPATHY
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Z A L D I ACUTE GLAUCOMA
TREATMENT ( MEDICAL )
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Acute Glaucoma is an ophthalmic emergency!
REDUCING IOP :1. Intravenous and oral acetazolamide
2. Topical agents : beta-blockers and apraclonidine,
3. Hyperosmotic agents : mannitol 20% , glicerol 50 %
4. Pilocarpine 2% , 4% ( by which time reduction of iris
ischemia and lowering of intraocular pressure allow
the sphincter pupillae to respond to the drug.
TOPICAL STEROIDS to reduce secondary intraocular
inflammation ( controversial )
TREATMENT ( SURGERY )
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1. LASER PERIPHERAL IRIDOTOMY ( YAG Laser)
( to form a permanent connection between
the anterior and posterior chambers, thus
preventing recurrence of iris bombé )
2. TRABECULECTOMY & PERIPHERAL IRIDECTOMY
3. PROPHYLACTIC LASER IRIDOTOMY (fellow eye)
PERIPHERAL IRIDECTOMY
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TRABECULECTOMY
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GLAUCOMA Optic Neuropathy VF loss
Neuroprotection
OBFIOP
PP BPSclerotic vascular wall vasospasmIOP
Mechanical damage
Neutrophin withdrawal
Stop axoplasmic
flow
RetinaISCHEMIA
ONH
Vascular dysregulation
RGC death
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REFERENCES
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American Academy of Ophthalmology, Glaucoma,
Section 10, 2011-2012
American Academy of Ophthalmology, External
Disease and Cornea, Section 8, 2011-2012
Khurana AK, Comprehensive Ophthalmology, Fourth
Edition , New Delhi, New Age Internasional (p) Limited
Publisher, 2007.
Vaughan & Asbury's : General Ophthalmology
17th Edition , Mc Graw- Hill’s Companies , May 2007
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Segala puji bagi Allah, Tuhan semesta alam.
THANKS YOU
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