Z A L D I

FAKULTAS KEDOKTERAN

UNIVERSITAS MUHAMMADIYAH SUMATERA UTARA

MEDAN

2013

ACUTE GLAUCOMA

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Z A L D I ACUTE GLAUCOMA

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Dengan menyebut nama Allah

Yang Maha Pengasih Maha Penyayang.

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I. TUJUAN INSTRUKSIONAL UMUM

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Setelah Proses Belajar Mengajar mahasiswa

mampu menegakkan diagnosa glaukoma

akut dengan melakukan anamnese dan

pemeriksaan sederhana yang akan dipelajari

selama masa perkuliahan dengan baik dan

benar .

II. TUJUAN INSTRUKSIONAL KHUSUS

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Setelah Proses Belajar Mengajar mahasiswa

mampu mengetahui tanda dan gejala , faktor

resiko, prinsip pengobatan, komplikasi, dan

mengkonsulkan secara garis besar dengan

baik dan benar kasus-kasus glaukoma akut

sesuai dengan kompetensinya

DEFINITION

ACUTE GLAUCOMA

(“Acute angle closure”)

occurs when sufficient

iris bombé develops to

cause occlusion of the

anterior chamber angle

by the peripheral iris.

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Z A L D I ACUTE GLAUCOMA

CLASSIFICATION

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AQUEOUS HUMOR OUTFLOW

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AQUOS HUMOR OUTFLOW

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ETIOLOGY

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HYPEROPIC EYE AND CRYSTALLINE LENS ENLARGEMENT

SPONTANEOUSLY PUPILLARY DILATION

( when the level of illumination is reduced )

DRUGS ( anticholinergic or sympathomimeticeg, atropine , antidepressants, nebulizedbronchodilators, nasal decongestants, or tocolytics).

HYPEROPIC EYE AND CRYSTALLINE LENS ENLARGEMENT

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CLINICAL FINDINGS

SUDDEN ONSET OF VISUAL LOSS

PHOTOPHOBIA

HALOS

NAUSEA AND VOMITING

INCREASED INTRAOCULAR PRESSURE

STEAMY CORNEA

CILIARY INJECTION

SHALLOW ANTERIOR CHAMBER

MODERATELY DILATED PUPIL

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DIFFERENTIAL DIAGNOSIS ( 1 )

1. ACUTE IRITIS

o more photophobia ,

o IOP not elevated

o pupil is constricted or

irregular in shape

o cornea not edematous.

o flare and cells in AC

o deep ciliary injection.

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DIFFERENTIAL DIAGNOSIS ( 2 )

2. ACUTE CONJUNCTIVITIS

bilateral

cornea is clear.

no photophobia ,

no visual loss

no ciliary injection

discharge

pupillary responses

IOP normal

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COMPLICATIONS

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1. ANTERIOR SYNECHIAE ( the peripheral

iris may adhere to the trabecular

meshwork )

2. IRREVERSIBLE OCCLUSION AC

3. OPTIC NEUROPATHY

OPTIC NEUROPATHY

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TREATMENT ( MEDICAL )

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Acute Glaucoma is an ophthalmic emergency!

REDUCING IOP :1. Intravenous and oral acetazolamide

2. Topical agents : beta-blockers and apraclonidine,

3. Hyperosmotic agents : mannitol 20% , glicerol 50 %

4. Pilocarpine 2% , 4% ( by which time reduction of iris

ischemia and lowering of intraocular pressure allow

the sphincter pupillae to respond to the drug.

TOPICAL STEROIDS to reduce secondary intraocular

inflammation ( controversial )

TREATMENT ( SURGERY )

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1. LASER PERIPHERAL IRIDOTOMY ( YAG Laser)

( to form a permanent connection between

the anterior and posterior chambers, thus

preventing recurrence of iris bombé )

2. TRABECULECTOMY & PERIPHERAL IRIDECTOMY

3. PROPHYLACTIC LASER IRIDOTOMY (fellow eye)

PERIPHERAL IRIDECTOMY

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TRABECULECTOMY

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GLAUCOMA Optic Neuropathy VF loss

Neuroprotection

OBFIOP

PP BPSclerotic vascular wall vasospasmIOP

Mechanical damage

Neutrophin withdrawal

Stop axoplasmic

flow

RetinaISCHEMIA

ONH

Vascular dysregulation

RGC death

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REFERENCES

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American Academy of Ophthalmology, Glaucoma,

Section 10, 2011-2012

American Academy of Ophthalmology, External

Disease and Cornea, Section 8, 2011-2012

Khurana AK, Comprehensive Ophthalmology, Fourth

Edition , New Delhi, New Age Internasional (p) Limited

Publisher, 2007.

Vaughan & Asbury's : General Ophthalmology

17th Edition , Mc Graw- Hill’s Companies , May 2007

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Segala puji bagi Allah, Tuhan semesta alam.

THANKS YOU

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