Opt acute glaucoma

Acute GlaucomaI made Agus Kusumadjaja

• Sudden visual loss

• Glaucoma def : optic neuropathy / characterized optic disk cupping – visual field loss – elevated intraocular pressure is risk factor

• Elevated IOP caused by occlusion the anterior chamber angle suddenly Acute glaucoma / IOP > 40 mmHg

• Type : primary Etiology ? Secondary Etiology +

Prevalence

• 60 million people have glaucoma

• 3 million Americans

• Indonesia ?

• 215 new cases at Sanglah hospital & indra hospital / 81 % blindness

• 2nd people blindness is glaucoma

NEUROPATI OPTIK YG PROGRESIF

HILANG LAPANGAN PANDANG

TIO FAKTOR RISIKO

DEFINISI :

TIO ↑ KRONIS GLAUKOMA KRONIS

TIO ↑ AKUT GLAUKOMA AKUT

TIO ↑ KETIDAKSEIMBANGAN PRODUKSI & SEKRESI

HUMOR AKUOS

PENEKANAN SERABUT SARAF OPTIK

ALIRAN DARAH ↓↓

ISKEMIK

KEMATIAN SERABUT SARAF

GANGGUAN PENGLIHATAN & LAPANG PANDANG

Physiology of aqueous humor

• Intraocular pressure is determined by the rate of aqueous production and the resistance to outflow of aqueous from the eye

Clinical measurement of IOP

• Shiotz – type indentation tonometer

» Goldmann – type applanation tonometry

Cara mendiagnosis Glaukoma

• TIO Palpasi: TN/-,+

Normal IOP in the general populations 10 – 21

PENGARUH TINGGINYA TIO THD WAKTU TIMBULNYA

GANGGUAN LAPANG PANDANG

Tingginya TIO Waktu timbulnya gangguan Lapang

Pandang

21 – 25 mmHg> 25 – 30 mmHg

> 30 mmHg

14,4 th kemudian6,5 th kemudian2,9 th kemudian

TINGGI TIO TERHADAPPROSENTASE KERUSAKAN SARAF OPTIK

Tingginya TIO % Kerusakan

25 – 2930 – 3435 – 3940 – 4445 – 49

> 50

71452617383

Cara mendiagnosis Glaukoma

• Oftalmoskopi • Papil N II ( Optic Nerve)

Cara mendiagnosis Glaukoma

• Perimetri

Cara mendiagnosis Glaukoma

Gonioskopi

• Pelayanan tingkat tersier – Glaukoma primer sudut

tertutup • Akut• Kronis

– Glaukoma primer sudut terbuka

– Glaukoma kongenital• Juvenile• Infantil

– Glaukoma sekunder et causa

• Sudut tertutup• Sudut terbuka

– Lain-lain • Hipertensi okuli• Glaukoma suspek• Glaukoma namotensi

• Pelayanan tingkat sekunder– Glaukoma primer sudut

tertutup• Akut• Kronis

– Glaukoma primer sudut terbuka

– Glaukoma kongenital– Glaukoma sekunder– Lain - lain

• Pelayanan tingkat primer• Glaukoma akut• Glaukoma kronis

Primary ACUTE GLAUCOMA/ ANGLE CLOSURE GLAUCOMA

• History : Monocular pain• Photophobia• Red eye• Blurred vision• Halos• Nausea and vomiting

• Finding on examination :

• High IOP > 40 mmHg• Decreased visual acuity• Red eye with congested blood

vessels• Middilated ,sluggish or non

reactive pupil, often irregularly shaped

• Corneal edema ( clouddiness)• Shallow anterior chamber• Aqueous cell and flare on slit

lamp exm

Acute glaucoma

• Examination outline :• Check visual acuity• Check IOP• Check anterior segment :• Eye lid : edema• Conjungtiva: hyperhemis• Cornea: edema• Anterior chamber:shallow• Iris: edema/atrophy• Pupil:mid-dilation,

irregular shape,bowing forward

• Picture

Primary Acute glaucoma

• Treatment :• initial treatment low

IOP urgency ; acetazolamide , timolol 0,5 % , pilocarpine 1-2 %, glycerin

• Refer patient• Definitive treatment :

laser or surgical iridotomy

Secondary acute glaucoma

• Lens : - disloccation - Intumescence of the lens - Phacolitic Uveitis

Tumor

Trauma

Clinical finding

• Subjective: pain eye , headache , red eye , blur vision , halos ,vomiting

Objective : - eyelid : swelling - conjunctiva : hyperhemis /red - cornea : cloudy - anterior chamber - pupil - lens

Management

• Looking for cause

• Before send this ps to secondary or tersier

health care : anti galucoma / azetazolamid tab.

PACG , SYMPTOM

Glaukoma sekunder

Operasi Glaukoma

Surgical Iridectomy