Dr. T. Sarada M.S. Ophthalmology

 Congenital and developmental Glaucomas  Without associated anomalies - Primary congenital  With associated anomalies  ICE syndromes  Aniridia  Primary glaucomas  POAG  PACG  Secondary glaucomas  Open angle  Closed angle

 Clinical features  Photophobia, lacrimation, blepherospasm  Buphthalmos, corneal edema, descemet’s tears  Blue sclera,  Pathology  Trabecular dysgenesis  Evaluation under anaesthesia  IOP, corneal Diameter, disc evaluation, gonioscopy

 buphthalmos

 Treatment  Goniotomy  Trabeculotomy  Trabeculotomy + trabeculectomy

 Treatment  Goniotomy  Trabeculotomy  Trabeculotomy + trabeculectomy

 Congenital and developmental Glaucomas  Without associated anomalies - Primary congenital  With associated anomalies  ICE syndromes  Aniridia  Primary glaucomas  POAG  PACG  Secondary glaucomas  Open angle  Closed angle

 Congenital and developmental Glaucomas  Without associated anomalies - Primary congenital  With associated anomalies  ICE syndromes  Aniridia  Primary glaucomas  POAG  PACG  Secondary glaucomas  Open angle  Closed angle

 Risk factors  Heredity  Age  Myopia  Diabetes  Smoking  Htn  Thyroid dysfunction

 Etiopathogenesis  Increased trabecular resistance  Steroid responsiveness  Clinical features  Painless progressive field loss  Night blindness (filed loss + delayed dark adoptation)  Early loss of accommodation  Complete loss of vision

 IOP  Disc changes  Visual field changes

Lamellar dot sign Bayoneting sign splinter haemorrhage BARRING OF THE VESSELS

Relative Paracentral scotoma

Arcuate scotoma

Ring scotoma

 Tonometry  Gonioscopy  Fundoscopy – Disc changes  Slit-lamp examination  Perimetry  NFLA  Provocative test

 Provocative tests  Water drinking test (1 litre, IOP every 15 min, >8mm of Hg rise)  Bulbar pressure test  Prescoline test ( >8 mm of Hg)  Caffeine test ( >8 mm of Hg)  Phasing / diurnal variation test ( >8 mm of Hg)

 Treatment  Medical  Beta blockers (timolol)  Pilocarpine  CA inhibitors (dorzolamide)  Prostaglandins (latanoprost)  Adrenergics (apraclonidine)  Organ LASER trabeculoplasty

 Surgical – Filtering surgery  Trabeculectomy  Non penetrating filtering surgeries  Visco canolostomy  Deep sclerectomy

Rising of fornix based conjunctival flap

Partial thickness scleral flap

Dissection extending till limbal area

Preperation of deep scleral block

Excision of deep scleral block

Surgical peripheral iridectomy

suturing of superficial scleral flap & conjunctival flap

Filtering bleb