Download MBBS Ophthalmology PPT 54 Secondary Glaucoma 2 Lecture Notes

Secondary Glaucoma

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? Definition
? Types
? Causes

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? Treatment
Secondary Glaucoma

? Conditions with raised intraocular pressure

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due to pre existing ocular causes.

? May manifest as-
a. Secondary open angle Glaucoma
b. Secondary angle closure Glaucoma

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c. Mixed pattern

1] lens induced glaucoma/Phakogenic

i. Phacomorphic glaucoma

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i . Phacolytic glaucoma
i i. Phacoanaphylactic glaucoma
iv. Glaucoma associated with dislocated lens
[phakotopic]
v. Glaucoma capsulare/ Pseudoexfoliation

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syndrome
?Intra ocular inflammation (inflammatory glaucoma):

Associated with uveitis

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Inflammatory glaucoma

1] Iridocyclitis (both in acute phase & chronic phases)
2] Glaucomato-cyclitic crisis /Hypertensive

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uveitis (Posner and Schlossmann's syndrome)

3] Following perforated corneal ulcer
4] As a complication of Keratitis & scleritis

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3] Steroid-induced glaucoma

i. Iatrogenic cause

ii. It is associated with topical, periocular, systemic

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or intraocular steroid therapy.

iii. IOP rise after steroid therapy occurs more often

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with topical administration than with systemic

administration.

iv. Periocular injection of a long action steroid is

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the most dangerous route.

v. Intravitreal steroid use (Triamcinolone injection

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to treat intraocular neovascular or

inflammatory disease) can also cause a rise in

IOP.

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vi. The response of IOP to steroids is genetically

determined

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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:

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i. deposition of mucopolysaccharides in

trabecular meshwork

i . Reduced endothelial phagocytic activity

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i i. Inhibit synthesis of prostaglandins E and F

which otherwise increase aqueous out flow.

Treatment:

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i. Stop steroid
i . Treat with Drug for POAG
i i. Surgery if medical treatment is unable to

prevent damage to optic nerve

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4] Pigmentary Glaucoma

? Young myopic males
? Deposition of iris pigments in trabecular

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meshwork damage

? Krukenberg's spindle (over corneal endothelium)
? Gonioscopy (Sampaolesi's line)
Glaucoma associated with intra ocular

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tumours

Causes:

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i.

Episcleral venous hypertension

(obstruction beyond trabecular meshwork)

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ii. Obstruction of angle by seeding of tumour cel s

iii. Forward displacement of Lens-iris diaphragm

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eg- Thyroid exophthalmos,

Carotico-cavernous fistula

Superior vena cava syndrome

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metastatic carcinoma of orbit

Retinoblastoma

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Iris melanoma

Post-traumatic Glaucoma

[A] Blunt injury

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? Rise in IOP is biphasic
- early which lasts for few hours
- After few months/years (angle recession)
? Gonioscopy is confimatory diagnosis- deeper

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angle recess with widening of ciliary band

[B] Penetrating injury
[C] Chemical injury

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1.Neovascular glaucoma may be associated with

all of the following except:

a.Diabetes

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b.Hypertension
c. Central retinal vein occlusion
d. Intraocular tumours

1.Treatment of malignant glaucoma includes all

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except:

a.Topical atropine
b.Topical pilocarpine

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c. IV mannitol
d. Vitreous aspiration
1.Secondary glaucoma following corneal

perforation is due to:

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a.Central anterior synechiae formation
b.Peripheral anterior synechiae
c. Intraocular haemorrhage
d. Angle recession

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1.Glaukomflecken is a feature of:
a.Acute narrow-angle glaucoma
b.Pseudoexfoliative glaucoma
c. Juvenile glaucoma

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d.Phacolytic glaucoma
1.All of the following are true about pigmentary

glaucoma except:

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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

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related to iris colour

? After blunt trauma to eye Raja develops

circumcorneal congestion. Now, which test

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should be done?

? (a) Ultrasonography
? (b) Perimetry
? (c) Direct ophthalmoscopy

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? (d) intraocular pressure measurement.