Classification in Glaucoma
Open Angle Glaucoma
1. Primary open-angle glaucoma (POAG)
• It is the most common glaucoma.
• It is a disease of advanced age (after 40 years).
• It is usually bilateral.
Medical Treatment
a) B-blockers (Timolol, Betaxolol): They reduce fluid production. It causes burning, redness, punctate keratitis in the eye.
b) Adrenergic effects (Alpha-2 agonists; Brimonidine, Apraclonidine):
intraocular pressure; They decrease both by reducing aqueous secretion and by facilitating uveoscleral outflow.
c) Topical carbonic anhydrase inhibitor (Acetazolamide): It reduces fluid production.
d) Prostaglandins (Latanoprost, Bimatoprost): Facilitates uveoscleral outflow. It is the first choice in the medical treatment of POAG today because it lowers intraocular pressure better than alternatives and has less systemic side effects. Latanoprost (PGF2a) Darkening of eye color, increasing inflammation in the eye. It is contraindicated in inflammatory glaucoma.
e) Parasympathomimetics: It facilitates the flow of fluid by opening the angle. Pilocarpine Most commonly used
f) Systemic carbonic anhydrase inhibitor (Acetazolamide}: It reduces fluid production. It is mostly used in acute glaucoma crisis.
Surgical treatment of Glaucoma
a) Laser trabeculoplasty: It widens the trabecular meshwork.
b) Trabeculectomy: The most successful surgery
2. Ocular hypertension
The optic pit and visual field are normal despite high intraocular pressure.
3. Normal tension glaucoma
Although the intraocular pressure is normal, there is optic atrophy and visual field changes.
4. Secondary open-angle glaucoma
a) Due to inflammation
b) Pigmentary glaucoma
c) pseudoexfoliation glaucoma
d) Tumor glaucoma
e) Steroid glaucoma
Closed Angle Glaucoma
A. Angle closure due to pupillary block:
- In the pupillary space, in cases that cause synechia between the iris and the lens, it is the picture that occurs as a result of the pressure of the aqueous humor from the posterior chamber to the angle, which cannot pass into the anterior chamber.
- Example: Uveitis
B. Angle closure without pupillary block:
- It expresses the table that causes angle-closure glaucoma by applying pressure to the iris periphery although the pupillary space is open.
- Example: Ciliary melanoma
Closed Open Glaucoma Treatment:
1- Oral glycerol or IV mannitol
2- Oral or intravenous acetazolamide
3- Topical antiglaucomatous (beta-blockers, alpha-2 agonists, PGs)
4- Miotic drops (pilocarpine)
5- Laser iridotomy
Mydriatic is contraindicated in closed-angle glaucoma.
In order to determine the type of glaucoma, the iridocorneal angle must be measured. The ophthalmological device used for this is called GONYOSCOPE, and the procedure is called GONIOSCOPY.
