Presentation
We describe a case of a 68-year-old man, referred by his optometrist with suspected low-tension glaucoma, who presented with advanced cupped optic discs and field of vision loss that were subsequently found to be due to a giant prolactinoma. [ncbi.nlm.nih.gov]
Entire Body System
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Intermittent Claudication
Ginkgo biloba for intermittent claudication. Cochrane Database Syst Rev. 2013;6:CD006888. [ Links ] 112 Hilton MP, Zimmermann EF, Hunt WT. Ginkgo biloba for tinnitus. [scielo.br]
Skin
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Splinter Hemorrhage
The presence of splinter hemorrhages at the optic disk (10% of affected eyes) or of systemic arterial hypertension (diastolic blood pressure greater than 100 mm Hg) was associated with progression of visual field defects. [ncbi.nlm.nih.gov]
Among the findings are a halo or crescent of absence of retinal pigment epithelium around the disc, bilateral pre-chiasmal visual field defects, splinter hemorrhages at the disc margin, vascular dysregulation (low blood pressure, cold hands and feet, [ijo.in]
Splinter hemorrhages are common, and glaucomatous cupping and visual defects are frequent. • Cardiac arrhythmia • Blood dyscrasias • Severe anemia • Polycythemia vera • Hyperviscosity syndromes • Increased platelet adhesiveness • Vascular dysregulation [reviewofophthalmology.com]
Eyes
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Blurred Vision
These include: Changes in blood pressure Migraine headaches Blurred vision Stinging or itchy eyes We encourage you to see a specialist right away if you are experiencing the symptoms above. [willseye.org]
Side-effects from some eye drops may include a stinging sensation, red eyes, blurred vision, headaches, or changes in pulse, heartbeat or breathing. [umkelloggeye.org]
If you do notice any symptoms, they might include blurred vision, or seeing rainbow-coloured circles around bright lights. Both eyes are usually affected, although it may be worse in one eye. [nhs.uk]
You should call your doctor immediately if you begin experiencing symptoms, such as severe pain, nausea, and blurred vision. [healthline.com]
vision Photophobia Loss of libido Adrenergic Agonist Red eye Allergic follicular conjunctivitis Dry mouth Drowsiness Carbonic Andydrase Inhibitors Sulfa allergy Red eye Ocular itching Metallic taste Paresthesia of fingers or toes Headache Blood dyscrasias [decisionmakerplus.net]
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Retinal Pigmentation
The trabecular meshwork, choroidal and optic nerve vasculature, retinal pigment epithelium, and photoreceptors were normal in appearance. [ncbi.nlm.nih.gov]
Among the findings are a halo or crescent of absence of retinal pigment epithelium around the disc, bilateral pre-chiasmal visual field defects, splinter hemorrhages at the disc margin, vascular dysregulation (low blood pressure, cold hands and feet, [ijo.in]
pigment epithelium 13.8 to 28.0% in NTG Soares AS, Artes PH, Andreou P, Leblanc RP, Chauhan BC, Nicolela MT. [slideshare.net]
pigment epithelium at the disc border, often in the region of worst cupping Focal notching of the optic cup, often associated with nerve fibre layer defects and/or a highly localised, dense, arcuate field defect Drance (splinter) haemorrhages at the [macfarlaneoptometrist.com.au]
Workup
[…] circulation and migraine.10 In addition, studies have suggested an association of immune-related diseases with NTG, including an increased incidence of paraproteinemia and autoantibodies.11 Clinical Evaluation The most important part of the diagnostic workup [reviewofophthalmology.com]
A detailed workup including neuroimaging may be indicated in patients with decreased central visual acuity ( 20/40), patients under 50 years of age, individuals with visual field defects that respect the vertical rather than horizontal midline, and those [glaucomatoday.com]
Workup An evaluation to determine whether a patient has NTG should be done with a thorough history-taking. [aao.org]
Corneal Thickness Measurements in Normal-tension Glaucoma Workups: Is It Worth the Effort?. J Glaucoma. 2009 Apr 15 [Epub ahead of print]. Stewart WC, Reid KK. Incidence of systemic and ocular disease that may mimic low-tension glaucoma. [emedicine.medscape.com]
QT, RR, ST Intervals
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ST Elevation
Comparison of hemorheological variables in ST-elevation myocardial infarction versus those in non-ST-elevation myocardial infarction or unstable angina pectoris. [scielo.br]
Other ECG Findings
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Ischemic Changes
However, diffuse cerebral small-vessel ischemic changes were found more in patients with low-tension glaucoma (n 8) than control patients (n 1) (P .0196). [ncbi.nlm.nih.gov]
As a result, low OPP could lead to ischemic changes in the optic nerve head and glaucomatous visual field defect progression. [hindawi.com]
Ischemic changes in brain magnetic resonance imaging are more common in these patients [ 17, 55 ]. [journals.plos.org]
Treatment
Nifedipine and acetazolamide treatment seemed to show no advantage over no-treatment in our patients. [ncbi.nlm.nih.gov]
Treatment[edit] Without treatment, NTG leads to progressive visual field loss and in the last consequence to blindness. [en.wikipedia.org]
Prognosis
No firm evidence was obtained to indicate that treatment of the low-tension glaucoma improved the prognosis of the ocular course. [ncbi.nlm.nih.gov]
• Prognosis and therapy : • According to Collaborative Normal-Tension Glaucoma Study (CNTGS) • Goal - to achieve an lOP that is as low as possible, without the development of complications. • Aggressive reduction in IOP by 30% to reduce progressive [slideshare.net]
Clinical data about the disease, such as the rate of glaucomatous visual field defect progression and risk factors for disease progression, might be helpful to clinicians to estimate prognosis and devise treatment regimens. [hindawi.com]
An additional consideration is that the presence of a disc hemorrhage indicates that the disease has a poorer prognosis; in this situation you may want to treat more aggressively. [reviewofophthalmology.com]
Etiology
If vascular disease is important in the etiology of low-tension glaucoma, then it must be localized or vasospastic since this study does not support the concept of a generalized vascular etiology, either of an atheromatous or hyperviscous nature, for [ncbi.nlm.nih.gov]
Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10coded.com]
The etiology is poorly understood, but whatever it is, the level of IOP seems to determine whether the etiologic factors will lead to glaucomatous damage or not. [ijo.in]
Glaucoma Signs: Alternate Possible Explanations Misleading Ocular Conditions Etiologies that can result in visual field loss Etiologies that can predispose to glaucoma progression at normal IOPs • A large physiologic cup. [reviewofophthalmology.com]
Epidemiology
The epidemiological features of DH were studied in 58 low-tension glaucoma patients by examining them every one to four weeks from 6 to 32 months. [ncbi.nlm.nih.gov]
Although estimates vary widely between studies, taken together, epidemiologic studies suggest that throughout the world, NTG represents perhaps 50% or more of all open-angle glaucoma. The more we look, the more we find, Dr. Park said. [eyeworld.org]
Synthesizes a classical approach to the glaucomas-based on seven earlier editions spanning over 40 years-with the most up-to-date evidence-based and epidemiologically-derived classifications and outcomes.Coherently correlates with authoritative consensus [books.google.com]
In a large epidemiologic study assessing the prevalence of glaucoma, it was found that an estimated 30 percent of patients diagnosed with OAG had NTG (3)(4), and Asian populations appear to be particularly prone to NTG; the Japanese Tajimi study cited [theophthalmologist.com]
For example, 92% of Japanese patients from a cross-sectional epidemiologic study presented with this form of glaucoma.3 RISK FACTORS IOP is currently the only modifiable risk factor for the development and progression of all types of glaucoma. [glaucomatoday.com]
Pathophysiology
Physiological and pathophysiological aspects of ocular blood flow and of microcirculation and hemorrheology will be considered and the significance of ocular vasospasm in low-tension glaucoma discussed. [ncbi.nlm.nih.gov]
This video discusses the three main types of glaucoma—open-angle glaucoma, closed-angle glaucoma, and normal-tension glaucoma, as well as the pathophysiology, diagnosis, and treatment. Find our complete video library only on Osmosis Prime: . [youtube.com]
Its fundamental nature seems to be pathophysiology of the optic nerve, the rate and severity of which is affected by the level of intraocular pressure (IOP). [ijo.in]
Glaucoma Pathophysiology Glaucoma Causes [news-medical.net]
Prevention
Management follows the same principle of other chronic glaucomas, to lower the IOP by a substantial amount, enough to prevent disabling visual loss. However, many NTG cases are non-progressive. [ncbi.nlm.nih.gov]
Can You Prevent It? Unfortunately, you can't prevent glaucoma. But blindness from the condition can often be prevented if it's diagnosed and treated early. So keep up with your regular eye exams done by an ophthalmologist. Pagination [webmd.com]
However, if a case seems typical and likely to progress, initiation of treatment would be prudent in order to prevent functional vision loss. [macfarlaneoptometrist.com.au]
Dips in blood pressure or a generally low blood pressure have to be prevented - which is a rather uncommon approach in modern medicine where high blood pressure is always seen as an immense clinical challenge, affecting large segments of the population [en.wikipedia.org]