1. Understanding Glauco ma

2. Femi Babalola Rachel eye center Garki, Abuja.

3. What is ‘Glaucoma’ A group of diseases. A cause of irreversible blindness. Characterised by three signs: – -Raised intraocular pressure – -Damage to the optic nerve – - Visual field loss.

4. Glaucoma can be... A. Primary (without an obvious or known cause) B. Secondary (with an attributable cause)

5. Glaucoma can also be Acute : sudden onset, painful, with wateriness and redness of the eyes. Chronic: gradual, insidious, painless.

6. Glaucoma can also be characterised as having: Closed angle Open angle

7. The ‘angle’ of the eye.

8. Hence the terms: Primary open angle glaucoma. (POAG) Primary closed angle glaucoma (PCAG) Acute angle closure glaucoma Chronic angle closure glaucoma

9. Commonest type : POAG Primary open angle glaucoma. Known colloquially as the ‘slow thief of sight’. Insidious onset Painless Often discovered during a refraction or other routine exam

10. Risk factors Age over 40 African descent. Diabetics Hypertension Raised IOP Close relative with glaucoma

11. The eye as a plumbing system

12. Blocked drainage : accumulation of fluid (in a closed system this causes elevated IOP

13. Blocked outflow channel

14. The ‘angle’ of the eye.

15. POAG: the angle is open but facility of outflow is reduced.

16. Narrow angle impairs outflow

17. Closed angle blocks outflow

18. The optic nerve: an electric cable connecting the eye to the brain

19. Raised IOP and nerve damage

20. Normal optic nerve and retina

21. Progressive optic nerve damage

22. Details: nasalisation of vessels, lamina cribrosa, bayonet sign

23. Optic nerve damage causes visual field loss.

24. Symptoms resulting: Bumping into objects by the side Seeing ‘rainbows’ around light bulbs. (raised IOL causes ‘water logging’ of the cornea.) Change glasses frequently. (a vain attempt to overcome visual difficulties). Find it difficult to see at night.

25. A normal eye sees...

26. A glaucomatous eye sees...

27. Investigations: slit lamp microscopy

28. Intraocular pressure: applanation

29. Non contact Tonometry

30. Gonioscopy: a study of the angle

31. Disc photographic analysis and computerised visual field test

32. Others: nerve fibre layer assessments GDX VCC OPTICAL COHERENCE TOMOGRAPHY (OCT)

33. Management EARLY DIAGNOSIS IS THE KEY Treatment is targeted at: Lowering intraocular pressure – Medically using eye drops and tablets – Surgically by performing a trabeculectomy, trabeculotomy, canaliculoplasty etc – LASER trabeculoplasty.

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