Open-angle glaucoma: Difference between revisions
No edit summary |
(Text replacement - "* " to "*") |
||
| Line 4: | Line 4: | ||
===Risk Factors=== | ===Risk Factors=== | ||
* Age (4% prevalence in age >80) | *Age (4% prevalence in age >80) | ||
* Race (3 times higher in Black patients) | *Race (3 times higher in Black patients) | ||
* Family History (2-3 fold increase for individuals with affected sibling or parent) | *Family History (2-3 fold increase for individuals with affected sibling or parent) | ||
* [[Hypertension]] | *[[Hypertension]] | ||
* [[Diabetes]] | *[[Diabetes]] | ||
* Other: Myopia, pseudoexfoliation, low diastolic perfusion pressure, cardiovascular disease, [[hypothyroidism]] | *Other: Myopia, pseudoexfoliation, low diastolic perfusion pressure, cardiovascular disease, [[hypothyroidism]] | ||
===Pathophysiology=== | ===Pathophysiology=== | ||
| Line 16: | Line 16: | ||
==Clinical Features== | ==Clinical Features== | ||
''Most commonly presents with progressive peripheral vision loss, followed by central vision loss'' | ''Most commonly presents with progressive peripheral vision loss, followed by central vision loss'' | ||
* Painless | *Painless | ||
* Cupping of the optic disc | *Cupping of the optic disc | ||
* Loss of peripheral visual field | *Loss of peripheral visual field | ||
* Preservation of central vision | *Preservation of central vision | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Line 27: | Line 27: | ||
===Testing=== | ===Testing=== | ||
====[[Fundus examination]]==== | ====[[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]] | ||
| Line 35: | Line 35: | ||
====[[Intraocular pressure]]==== | ====[[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 | ||
===Diagnosis=== | ===Diagnosis=== | ||
At least one of the following: | 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) | ||
* Adult Onset | *Adult Onset | ||
* Open, normal appearing anterior chamber angles | *Open, normal appearing anterior chamber angles | ||
* Absence of known secondary causes of open-angle glaucoma | *Absence of known secondary causes of open-angle glaucoma | ||
==Management== | ==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 agonist: Brimonidine 0.2% one drop BID | *α-adrenergic agonist: Brimonidine 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== | ==Disposition== | ||
Indications for ophthalmologic referral: | Indications for ophthalmologic referral: | ||
* IOP>40mmHg: emergency referral | *IOP>40mmHg: emergency referral | ||
* IOP 30-40 mmHg: referral within 24hr if no symptoms suggesting acute glaucoma | *IOP 30-40 mmHg: referral within 24hr if no symptoms suggesting acute glaucoma | ||
* IOP 25-29 mmHg: Evaluation within 1 week | *IOP 25-29 mmHg: Evaluation within 1 week | ||
* IOP 23-24 mmHg: repeat measurement and referral for comprehensive eye examination | *IOP 23-24 mmHg: repeat measurement and referral for comprehensive eye examination | ||
==See Also== | ==See Also== | ||
Revision as of 10:45, 14 July 2017
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 (3 times higher in Black patients)
- 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
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
Testing
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
Diagnosis
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
Management
- β-blockers: Timolol maleate 0.25%-0.5%, one drop BID
- α-adrenergic agonist: Brimonidine 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 ophthalmologic 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