1. SECONDARY GLAUCOMAS
Dr. Shinisha Paul

2. Glaucoma
Progressive optic neuropathy associated with visual field defects with/without raise in IOP
Primary / Secondary

3. Secondary Glaucomas
Group of disorders in which raised IOP is associated with some primary ocular or systemic disease
May show characteristics of either angle closure or open angle glaucoma
Outflow channels affected iris pushed forward ACG
Pigment deposits in trabecular meshwork OAG

4. Classification Pseudoexfoliation Pigmentary Neovascular Inflammatory
Lens induced
Aphakic or Pseudophakic
Steroid induced
Malignant

5. Pseudoexfoliation Glaucoma
Affects elderly
Unilateral in 60%
Exfoliative material deposited on iris, ciliary region and capsule of lens
Appear as flakes on anterior capsule of lens and pupillary margin
Collect in angle of anterior chamber and obstruct aqueous humor drainage
Management : as in POAG

8. Pigmentary glaucoma Pigment release in young male myopes.
Complaints of intermittent halos.
Krukenberg spindle of pigment on corneal endothelium.
Sampolesi line on gonioscopy.
Pigment dispersion syndrome.
Field loss in few eyes.
Long term prognosis is good.
Management : as in POAG.

11. Neovascular glaucoma Extensive retinal ischemia – CRVO and PDR
Rubeosis iridis
Fibrosis
Adhesion of iris to the cornea at angle
ACG

14. Management
Medical therapy : to control IOP
Filtration surgery
Panretinal photocoagulation
Prevent further neovascularisation.

15. Inflammatory Glaucoma
Uveitic glaucoma – swelling and dysfunction of endothelial cells or infiltration and obstruction of trabecular meshwork by inflammatory material
Postinflammatory glaucoma – extensive posterior synchiae : occlusion pupillae, iris bombe
Glaucomatocyclitic crisis – acute, recurrent, mild uveitis, high IOP : resolves in days to week
Fuchs heterochromic iridocyclitis – chronic, low grade iritis with cataract and glaucoma

20. Lens induced Glaucoma
Phacomorphic Glaucoma : swollen intumescent lens obliterates the drainage angle
Phacolytic Glaucoma :lens protein from hypermature lens escape into aqueous
Treatment : extraction of lens after lowering of intraocular pressure. All lens matter must be evacuated.

24. Aphakic or Pseudophakic Glaucoma
Secondary rise of IOP after cataract surgery
Caused by viscoelastics, distortion of angle structures or haemorrhage
Resolve spontaneously in a few days to week

25. Steroid induced glaucoma
Open angle
5% high responders, 35% moderate, 60% non- responders
GAG theory
Corticosteroids inhibit release of hydrolases
GAG in TM cannot depolarise
retain water in ECS
narrowing of trabecular spaces
decrease in aqueous outflow

26. Endothelial cell theory
Corticosteroids
Suppressed phagocytic activity of endothelial cells
Collection of debris in TM
Decrease in aqueous outflow
Prostaglandin theory
Inhibits synthesis of PGE & PGF

27. Management
Regular monitoring of IOP
Discontinuation of steroids – IOP normalises within 10 d – 4 wks.
Medical therapy
Filtration surgery

28. Malignant Glaucoma Aqueous misdirection syndrome
Causes : iridectomy, filtering surgery, laser iridotomy, cataract surgery, capsulotomy
C/F : severe pain, blurring of vision, shallow AC, high IOP.
Management : Cycloplegic (deepens AC), osmotic agent (dehydrates vitreous), beta blockers (carbonic anhydrase inhibitors), YAG laser, hyaloidotomy, pars plana vitrectomy