Download MBBS Ophthalmology PPT 54 Secondary Glaucoma 2 Lecture Notes

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
v. Glaucoma capsulare/ Pseudoexfoliation

?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


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


vi. The response of IOP to steroids is genetically


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
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.

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




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


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:

c. Central retinal vein occlusion
d. Intraocular tumours

1.Treatment of malignant glaucoma includes all


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