Internal Medicine

0521779407-08 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:47

Glaucoma 627

■prevalence increases 5 times in African-Americans

■nearsightedness is a risk for open angle

■farsightedness is a risk for closed angle

■main risk is high intraocular pressure (usually over 20)

■glucocorticoid use also a risk factor (usually topically or intrana-

sal)

Signs & Symptoms

■Open angle glaucoma is without symptoms

■Closed angle glaucoma preceded by periodic misty vision or rainbow

colored haloes

■Acute closed angle causes sudden, severe trigeminal pain, blurring

and often associated nausea

■intraocular pressure (I0P) is usually elevated

■optic nerve cup is expanded – loss of rim tissue

■A thin cornea (<555 microns) triples risk of glaucoma

■visual acuity is usually normal in chronic glaucomas

■secondary glaucomas may mimic primary disease, angle recession,

exfoliation, pigmentary, steroid induced

tests

■Tonometry to check IOP-tonopen or Applanation

■Visual field testing-automated

■Optic nerve visualization

■Gonioscopy to visualize open and normal angle

differential diagnosis

■Ocular hypertension

■Inaccurate pressure readings

■Physiologic cupping of the optic nerve

■Angle closure glaucoma

■Acute glaucomas mimic other causes of painful red eye: corneal

ulcers, keratitis, iritis

management

General Measures

■Obtain accurate pressure data

■Determine degree of damage by nerve appearance and field testing

■Photography of optic nerve

■Optic nerve analysis with HRT, OCT or GDX

■Baseline threshold visual field

■Determine target pressure level (depends on damaging pressure

level and presenting degree of damage)