Ophthalmology Book

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Glaucoma

Aka: Glaucoma
  1. See Also
    1. Open Angle Glaucoma
    2. Narrow Angle Glaucoma
  2. Definition
    1. Increased Intraocular Pressure AND Optic Nerve injury
    2. High risk of blindness if untreated (acuity <20/200)
  3. Epidemiology
    1. Within top 3 causes of blindness in U.S.
      1. Leading cause of blindness in non-white
    2. U.S. Prevalence: 2 Million
      1. Only 50% are estimated to now be under treatment
      2. 120,000 are blind due to Glaucoma
      3. Highest risk groups for Glaucoma-related blindness in Blacks and Hispanics
    3. World Prevalence: 80 Million (estimated by 2020)
      1. Bilateral blindness due to Glaucoma estimated at 11 million worldwide by 2020
  4. Pathophysiology
    1. Elevated Intraocular Pressure (IOP)
      1. Increased production of Aqueous Humor by ciliary body
      2. Increased outflow resistance at Aqueous Outflow Angle
        1. Trabecular meshwork
        2. Canal of Schlemm
    2. Progressive changes in optic disc
      1. Nerve damage related to increased IOP is variable
        1. Glaucoma suspects (66% of those with high IOP)
          1. No damage despite high Intraocular Pressure (>21)
          2. Optic Nerve injury rate in suspects: 1% per year
        2. Normal-pressure Glaucoma (15% of Glaucoma patients)
          1. Normal Intraocular Pressure (21 mmHg or less)
          2. Glaucoma-related Optic Nerve damage
      2. Progressive Glaucomatous cupping at the optic disc
        1. IOP collapses Optic Nerve head structural support
        2. Axons destroyed by mechanical compression
    3. Peripheral visual field loss
      1. Open Angle Glaucoma: Slowly progressive
      2. Narrow Angle Glaucoma: Rapid Vision Loss
  5. Types
    1. Primary Glaucoma
      1. Open Angle Glaucoma (89% of cases)
        1. Outflow blocked by microscopic outflow changes
        2. Results in progressive peripheral Vision Loss
        3. Usually asymptomatic until 40% of nerve loss
      2. Narrow Angle Glaucoma (11% of cases)
        1. Outflow tract blocked by base of iris
        2. Permanent Vision Loss may occur in hours
        3. Presents as acute painful Red Eye with Vomiting
    2. Secondary Glaucoma
      1. Medications that increase IOP in those predisposed
        1. Corticosteroids (Systemic and Topical)
          1. Reversible
        2. Mild Adrenergic or Anticholinergic Medications
          1. Examples
            1. Cold Medications
            2. Antidepressants
            3. Antidiarrheals
          2. Effect: Dilate Pupil
            1. Theoretically worsen angle closure Glaucoma
            2. Not contraindicated in Glaucoma
  6. Resources
    1. Aging Eye Glaucomatrac (Glaucoma Management Tracking)
      1. http://www.agingeye.net/glaucomacharting.index
    2. Aging Eye Glaucoma Video
      1. http://www.agingeye.net/mainnews/video.php
  7. References
    1. Alward (1998) N Engl J Med 339:1298-307 [PubMed]
    2. Distelhorst (2003) Am Fam Physician 67(9):1937-50 [PubMed]
    3. Gupta (2016) Am Fam Physician 93(8):668-74 [PubMed]
    4. Infeld (1998) Postgrad Med 74:709-15 [PubMed]

Glaucoma (C0017601)

Definition (MEDLINEPLUS)

Glaucoma is a group of diseases that can damage the eye's optic nerve. It is a leading cause of blindness in the United States. It usually happens when the fluid pressure inside the eyes slowly rises, damaging the optic nerve. Often there are no symptoms at first. Without treatment, people with glaucoma will slowly lose their peripheral, or side vision. They seem to be looking through a tunnel. Over time, straight-ahead vision may decrease until no vision remains.

A comprehensive eye exam can tell if you have glaucoma. People at risk should get eye exams at least every two years. They include

  • African Americans over age 40
  • People over age 60, especially Mexican Americans
  • People with a family history of glaucoma

There is no cure, but glaucoma can usually be controlled. Early treatment can help protect your eyes against vision loss. Treatments usually include prescription eyedrops and/or surgery.

NIH: National Eye Institute

Definition (MSHCZE) Zelený zákal. Onemocnění charakterizované zvýšeným nitroočním tlakem a následnými změnami vnitřních částí oka a poškozením zrakového nervu, které vede k poruchám vidění. G. postihuje až 2% populace středního a vyššího věku a v rozvinutých zemích patří k nejč. příčinám slepoty. Objeví-li se na oku zdravém, jde o primární g., jeho příčina není zcela jasná, je-li důsledkem jiného očního onemocnění (oční záněty, úraz aj.), jde o g. sekundární. Podstatou většiny druhů g. je zvýšení tlaku komorové vody v oku (zvýšená tvorba či poruchy jejího odtoku). Tento tlak lze při odborném očním vyšetření změřit. Akutní g. (vzácnější) se projevuje akutními záchvaty silné bolesti oka a hlavy, světloplachostí, zarudnutím oka, viděním barevných kruhů kolem zdrojů světla a různě velkou poruchou vidění (např. mlhavé vidění), někdy i nevolností a zvracením. Zrak se vlivem záchvatů zhoršuje, k čemuž může docházet postupně – a zákeřně – i bez akutních záchvatů (u chronického g. častější). Podstatou léčby je snižování nitroočního tlaku. Používají se oční kapky pilokarpin, betablokátory, popř. některé vnitřně podané léky snižující tvorbu komorové vody. V některých případech se používá laser nebo se provádí operace. Včasně zahájená a pečlivě prováděná léčba umožní nemoc zastavit a zabránit tak těžkému porušení zraku či dokonce slepotě. Vzniklá poškození však již nelze odstranit, proto je důležitá včasná diagnóza a pečlivé dodržování léčby. Některé vnitřně podané léky (atropin, spasmolytika) mohou u nemocného glaukomem vyvolat záchvat; řec. glaukos modrozelený. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ )
Definition (NCI_CTCAE) A disorder characterized by an increase in pressure in the eyeball due to obstruction of the aqueous humor outflow.
Definition (NCI_NCI-GLOSS) A condition in which there is a build-up of fluid in the eye, which presses on the retina and the optic nerve. The retina is the layer of nerve tissue inside the eye that senses light and sends images along the optic nerve to the brain. Glaucoma can damage the optic nerve and cause loss of vision or blindness.
Definition (NCI) Increased pressure in the eyeball due to obstruction of the outflow of aqueous humor.
Definition (MSH) An ocular disease, occurring in many forms, having as its primary characteristics an unstable or a sustained increase in the intraocular pressure which the eye cannot withstand without damage to its structure or impairment of its function. The consequences of the increased pressure may be manifested in a variety of symptoms, depending upon type and severity, such as excavation of the optic disk, hardness of the eyeball, corneal anesthesia, reduced visual acuity, seeing of colored halos around lights, disturbed dark adaptation, visual field defects, and headaches. (Dictionary of Visual Science, 4th ed)
Definition (CSP) group of diseases characterized by increased intraocular pressure resulting in damage to the optic nerve and retinal nerve fibers.
Concepts Disease or Syndrome (T047)
MSH D005901
ICD9 365.9, 365
ICD10 H40, H40-H42.9, H40.9, H40-H42
SnomedCT 155120009, 194631001, 193569008, 23986001
LNC MTHU020819, LA16302-4
English Glaucomas, Glaucoma, Unspecified glaucoma, Glaucoma NOS, Glaucoma, unspecified, glaucoma (diagnosis), glaucoma, Glaucoma [Disease/Finding], glaucomas, Glaucoma (H40-H42), Glaucoma NOS (disorder), GLAUCOMA, Glaucoma (disorder), Glaucoma, NOS
French GLAUCOME, Glaucome SAI, Glaucome, non précisé, Glaucome non précisé, Glaucome
Portuguese GLAUCOMA, Glaucoma NE, Glaucoma
Spanish GLAUCOMA, Glaucoma no especificado, Glaucoma NEOM, glaucoma, SAI (trastorno), glaucoma, SAI, glaucoma (trastorno), glaucoma, Glaucoma
German GLAUKOM, Glaukom, unspezifisch, Glaukom NNB, unspezifisches Glaukom, Glaukom, nicht naeher bezeichnet, Glaukom, Star, grüner
Dutch glaucoom NAO, glaucoom, niet-gespecificeerd, niet-gespecificeerd glaucoom, Glaucoom, niet gespecificeerd, glaucoom, Glaucoom
Italian Glaucoma NAS, Glaucoma non specificato, Glaucoma
Japanese 緑内障NOS, 緑内障, 詳細不明の緑内障, 緑内障、詳細不明, ショウサイフメイノリョクナイショウ, リョクナイショウNOS, リョクナイショウショウサイフメイ, リョクナイショウ
Swedish Grön starr
Czech zelený zákal oční, glaukom, Glaukom, Blíže neurčený glaukom, Glaukom NOS, zelený zákal
Finnish Glaukooma
Russian GLAUKOMA, ГЛАУКОМА
Korean 상세불명의 녹내장, 녹내장
Croatian GLAUKOM
Polish Jaskra
Hungarian Glaucoma k.m.n., Glaucoma, nem meghatározott, Glaucoma, Nem meghatározott glaucoma
Norwegian Glaukom, Grønn stær
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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