Download MBBS (Bachelor of Medicine, Bachelor of Surgery) Ophthalmology PPT 54 Secondary Glaucoma 2 Lecture Notes
Secondary Glaucoma
-
? Definition
? Types
? Causes
? Treatment
Secondary Glaucoma
? Conditions with raised intraocular pressure
due to pre existing ocular causes.
? May manifest as-
a. Secondary open angle Glaucoma
b. Secondary angle closure Glaucoma
c. Mixed pattern
1] lens induced glaucoma/Phakogenic
i. Phacomorphic glaucoma
i . Phacolytic glaucoma
i i. Phacoanaphylactic glaucoma
iv. Glaucoma associated with dislocated lens
[phakotopic]
v. Glaucoma capsulare/ Pseudoexfoliation
syndrome
?Intra ocular inflammation (inflammatory glaucoma):
Associated with uveitis
Inflammatory glaucoma
1] Iridocyclitis (both in acute phase & chronic phases)
2] Glaucomato-cyclitic crisis /Hypertensive
uveitis (Posner and Schlossmann's syndrome)
3] Following perforated corneal ulcer
4] As a complication of Keratitis & scleritis
3] Steroid-induced glaucoma
i. Iatrogenic cause
ii. It is associated with topical, periocular, systemic
or intraocular steroid therapy.
iii. IOP rise after steroid therapy occurs more often
with topical administration than with systemic
administration.
iv. Periocular injection of a long action steroid is
the most dangerous route.
v. Intravitreal steroid use (Triamcinolone injection
to treat intraocular neovascular or
inflammatory disease) can also cause a rise in
IOP.
vi. The response of IOP to steroids is genetically
determined
vii. Rise in IOP occurs 6 weeks to 2 months
viii. Response varies in people
ix. Reversible
X . But we need to treat till it comes down
Pathogenesis:
i. deposition of mucopolysaccharides in
trabecular meshwork
i . Reduced endothelial phagocytic activity
i i. Inhibit synthesis of prostaglandins E and F
which otherwise increase aqueous out flow.
Treatment:
i. Stop steroid
i . Treat with Drug for POAG
i i. Surgery if medical treatment is unable to
prevent damage to optic nerve
4] Pigmentary Glaucoma
? Young myopic males
? Deposition of iris pigments in trabecular
meshwork damage
? Krukenberg's spindle (over corneal endothelium)
? Gonioscopy (Sampaolesi's line)
Glaucoma associated with intra ocular
tumours
Causes:
i.
Episcleral venous hypertension
(obstruction beyond trabecular meshwork)
ii. Obstruction of angle by seeding of tumour cel s
iii. Forward displacement of Lens-iris diaphragm
eg- Thyroid exophthalmos,
Carotico-cavernous fistula
Superior vena cava syndrome
metastatic carcinoma of orbit
Retinoblastoma
Iris melanoma
Post-traumatic Glaucoma
[A] Blunt injury
? Rise in IOP is biphasic
- early which lasts for few hours
- After few months/years (angle recession)
? Gonioscopy is confimatory diagnosis- deeper
angle recess with widening of ciliary band
[B] Penetrating injury
[C] Chemical injury
1.Neovascular glaucoma may be associated with
all of the following except:
a.Diabetes
b.Hypertension
c. Central retinal vein occlusion
d. Intraocular tumours
1.Treatment of malignant glaucoma includes all
except:
a.Topical atropine
b.Topical pilocarpine
c. IV mannitol
d. Vitreous aspiration
1.Secondary glaucoma following corneal
perforation is due to:
a.Central anterior synechiae formation
b.Peripheral anterior synechiae
c. Intraocular haemorrhage
d. Angle recession
1.Glaukomflecken is a feature of:
a.Acute narrow-angle glaucoma
b.Pseudoexfoliative glaucoma
c. Juvenile glaucoma
d.Phacolytic glaucoma
1.All of the following are true about pigmentary
glaucoma except:
a.It occurs more often in young myopic men
b.Iris transillumination defects are noted
c. It is associated with Krukenberg's spindle
d.The intensity of pigment deposit in the angle is
related to iris colour
? After blunt trauma to eye Raja develops
circumcorneal congestion. Now, which test
should be done?
? (a) Ultrasonography
? (b) Perimetry
? (c) Direct ophthalmoscopy
? (d) intraocular pressure measurement.
This post was last modified on 07 April 2022