Open-angle glaucoma

Background

Eye anatomy.

Eye angle anatomy.

Mechanism of open vs closed angle closure glaucoma.

• Elevated intraocular pressure and resulting optic nerve damage manifested initially as visual field loss and ultimately irreversible blindness if left untreated
• Unclear pathogenesis, however thought to be related to two mechanisms:
  • Increased aqueous production
  • Decreased outflow

Etiologies

• Primary
• Secondary
  • Another ocular disease
  • Systemic disease
  • Trauma
  • Drugs

Clinical Features

Retinal findings in advanced glaucoma disease.

• Rarely experience symptoms, in contrast to acute angle closure glaucoma
• Typical pattern characterized by progressive peripheral visual field loss followed by central field loss, usually but not always associated with elevated intraocular pressure

Differential Diagnosis

Acute Vision Loss (Noninflamed)

• Painful
  • Arteritic anterior ischemic optic neuropathy
  • Optic neuritis
  • Temporal arteritis^†
• Painless
  • Amaurosis fugax
  • Central retinal artery occlusion (CRAO)^†
  • Central retinal vein occlusion (CRVO)^†
  • High altitude retinopathy
  • Open-angle glaucoma
  • Posterior reversible encephalopathy syndrome (PRES)
  • Retinal detachment^†
  • Stroke^†
  • Vitreous hemorrhage
  • Traumatic optic neuropathy (although may have pain from the trauma)

^†Emergent Diagnosis

Evaluation

Workup

• Eye exam with IOP check

Diagnosis

• Characteristic nerve damage (eg, cupping) on fundus examination
• Visual field abnormalities
• +/- elevated IOP (>21 mmHg)

Management

• Typically managed chronically with long-term eye drops or outpatient procedures and does not typically requir immediate emergency intervention

Disposition

• Outpatient

See Also

• Acute angle-closure glaucoma