Open-angle glaucoma: Difference between revisions
No edit summary |
No edit summary |
||
| Line 24: | Line 24: | ||
==Evaluation== | ==Evaluation== | ||
=== Diagnosis with at least one of the following:=== | === Diagnosis with at least one of the following:=== | ||
* Evidence of optic nerve damage from structural abnormalities (thinning, cupping, notching of disc rim) | * Evidence of optic nerve damage from structural abnormalities (thinning, cupping, notching of disc rim) | ||
| Line 47: | Line 30: | ||
* Absence of known secondary causes of open-angle glaucoma | * Absence of known secondary causes of open-angle glaucoma | ||
=== Fundus examination === | |||
* Cupping >50% of the vertical disc diameter | * Cupping >50% of the vertical disc diameter | ||
* Thinning or notching of disc rim | * Thinning or notching of disc rim | ||
* Progressive change of size/shape of cup | * Progressive change of size/shape of cup | ||
[[File:glaucoma-cupping-1024x414.jpg|thumb|Glaucoma cupping]] | [[File:glaucoma-cupping-1024x414.jpg|thumb|Glaucoma cupping]] | ||
=== Visual Field testing === | |||
=== Intraocular pressure === | |||
* Does not establish diagnosis of Open angle glaucoma. 1/2 of patients with OAG have normal intraocular pressure | * Does not establish diagnosis of Open angle glaucoma. 1/2 of patients with OAG have normal intraocular pressure | ||
* Normal Intraocular pressure ranges from 10 to 20 mmHg | * Normal Intraocular pressure ranges from 10 to 20 mmHg | ||
* Pressure >21 mmhg considered ocular hypertension | * Pressure >21 mmhg considered ocular hypertension | ||
== | ==Management== | ||
* β-blockers: Timolol maleate 0.25%-0.5%, one drop BID | * β-blockers: Timolol maleate 0.25%-0.5%, one drop BID | ||
* α-adrenergic agonistBrimonidine 0.2% one drop BID | * α-adrenergic agonistBrimonidine 0.2% one drop BID | ||
* Carbonic Anhydrase inhibitors: Dorzolamide 2% one drop BID | * Carbonic Anhydrase inhibitors: Dorzolamide 2% one drop BID | ||
* Prostaglandins: Latanoprost 0.005% one drop qD | * Prostaglandins: Latanoprost 0.005% one drop qD | ||
* Persistent elevated intraocular pressures: Acetazolamide 125-250mg PO bid-qid | * Persistent elevated intraocular pressures: [[Acetazolamide]] 125-250mg PO bid-qid | ||
==Disposition== | |||
Indications for opthalmologic referral: | Indications for opthalmologic referral: | ||
* IOP>40mmHg: emergency referral | * IOP>40mmHg: emergency referral | ||
| Line 73: | Line 56: | ||
* IOP 23-24 mmHg: repeat measurement and referral for comprehensive eye examination | * IOP 23-24 mmHg: repeat measurement and referral for comprehensive eye examination | ||
=== References == | ==See Also== | ||
==External Links== | |||
==References== | |||
<references/> | |||
* Tsai LM, Pitha I, Kamenetzky SA. The Eye & Ocular Adnexa. In: Doherty GM. eds. CURRENT Diagnosis & Treatment: Surgery, 14e. New York, NY: McGraw-Hill; 2015. | * Tsai LM, Pitha I, Kamenetzky SA. The Eye & Ocular Adnexa. In: Doherty GM. eds. CURRENT Diagnosis & Treatment: Surgery, 14e. New York, NY: McGraw-Hill; 2015. | ||
* Weinreb RN, Khaw PT. Primary open-angle glaucoma. Lancet 2004; 363:1711 | * Weinreb RN, Khaw PT. Primary open-angle glaucoma. Lancet 2004; 363:1711 | ||
* UpToDate | * UpToDate | ||
* American Academy of Ophthalmology, Glaucoma Panel. Primary open-angle glaucoma. Preferred practice pattern. San Francisco: American Academy of Ophthalmology, 2000:1–36 | * American Academy of Ophthalmology, Glaucoma Panel. Primary open-angle glaucoma. Preferred practice pattern. San Francisco: American Academy of Ophthalmology, 2000:1–36 | ||
Revision as of 13:01, 4 December 2016
Background
- An optic neuropathy characterized by an increase in intraocular pressure leading to damage to the optic nerve and irreversible vision loss.
- Second leading cause of irreversible blindness worldwide
Risk Factors
- Age (4% prevalence in age >80)
- Race (3x higher in African Americans)
- Family History (2-3 fold increase for individuals with affected sibling or parent)
- Hypertension
- Diabetes
- Other: Myopia, pseudoexfoliation, low diastolic perfusion pressure, cardiovascular disease, hypothyroidism
Pathophysiology
Not entirely clear but may be related to an increased intraocular pressure that leads to compression of the optic nerve at the site where it exits the eye. This causes a progressive decrease in the number of retinal ganglion cells.
Clinical Features
Most commonly presents with progressive peripheral vision loss, followed by central vision loss
- Painless
- Cupping of the optic disc
- Loss of peripheral visual field
- Preservation of central vision
Differential Diagnosis
Evaluation
Diagnosis with at least one of the following:
- Evidence of optic nerve damage from structural abnormalities (thinning, cupping, notching of disc rim)
- Adult Onset
- Open, normal appearing anterior chamber angles
- Absence of known secondary causes of open-angle glaucoma
Fundus examination
- Cupping >50% of the vertical disc diameter
- Thinning or notching of disc rim
- Progressive change of size/shape of cup
Visual Field testing
Intraocular pressure
- Does not establish diagnosis of Open angle glaucoma. 1/2 of patients with OAG have normal intraocular pressure
- Normal Intraocular pressure ranges from 10 to 20 mmHg
- Pressure >21 mmhg considered ocular hypertension
Management
- β-blockers: Timolol maleate 0.25%-0.5%, one drop BID
- α-adrenergic agonistBrimonidine 0.2% one drop BID
- Carbonic Anhydrase inhibitors: Dorzolamide 2% one drop BID
- Prostaglandins: Latanoprost 0.005% one drop qD
- Persistent elevated intraocular pressures: Acetazolamide 125-250mg PO bid-qid
Disposition
Indications for opthalmologic referral:
- IOP>40mmHg: emergency referral
- IOP 30-40 mmHg: referral within 24hr if no symptoms suggesting acute glaucoma
- IOP 25-29 mmHg: Evaluation within 1 week
- IOP 23-24 mmHg: repeat measurement and referral for comprehensive eye examination
See Also
External Links
References
- Tsai LM, Pitha I, Kamenetzky SA. The Eye & Ocular Adnexa. In: Doherty GM. eds. CURRENT Diagnosis & Treatment: Surgery, 14e. New York, NY: McGraw-Hill; 2015.
- Weinreb RN, Khaw PT. Primary open-angle glaucoma. Lancet 2004; 363:1711
- UpToDate
- American Academy of Ophthalmology, Glaucoma Panel. Primary open-angle glaucoma. Preferred practice pattern. San Francisco: American Academy of Ophthalmology, 2000:1–36