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Open Angle Glaucoma

Compensated Glaucoma

Open-angle glaucoma stems from a reduced outflow of aqueous humor and is amongst the most important causes of blindness. Symptoms such as peripheral vision loss may not be apparent until severe optic nerve damage occurs. The diagnosis is made by a thorough physical exam and use of various ophthalmological procedures.


Presentation

Glaucoma is one of the leading causes of blindness in the general population, and open-angle glaucoma is the most common form [1] [2] [3]. Numerous risk factors for this disorder have been identified, including older age, genetic factors (a seven-fold increased risk is confirmed in the setting of a positive family history), trauma, use of corticosteroids (either topical or systemic), black race, and high intraocular pressure, which is considered to be the main event in the pathogenesis [3] [4] [5]. Unfortunately, one of the most prominent clinical features of glaucoma is that its symptoms appear only when substantial damage to the optic nerve and disk occurs [3] [4]. In fact, open-angle glaucoma is usually diagnosed incidentally, when examination of the eye is performed due to other causes [5]. Studies have shown that loss of more than 40% of optic nerve fibers is necessary to produce symptoms [5], and patients report a gradual loss of peripheral vision that is often perceived as tunnel vision [5] [6]. In most patients, open- angle glaucoma appears bilaterally, and inability to perform daily activities, such as driving and newspaper reading is often a consequence of the reduced visual field, while some patients report missing stairs as well [4]. Glaucoma invariably causes irreversible blindness in the absence of a timely diagnosis and an early appearance of vision-related symptoms must be taken seriously for that reason.

Mediastinal Lymphadenopathy
  • Computed tomography revealed bilateral hilar and mediastinal lymphadenopathy. Ophthalmological examination showed elevated intraocular pressure.[ncbi.nlm.nih.gov]
Lymphadenopathy
  • Computed tomography revealed bilateral hilar and mediastinal lymphadenopathy. Ophthalmological examination showed elevated intraocular pressure.[ncbi.nlm.nih.gov]
Myopathy
  • Kearns-Sayre syndrome is characterized by chronic progressive external ophthalmoplegia, tapetoretinal degeneration and severe generalized myopathy. We report on a 82-year-old male patient with Kearns-Sayre syndrome with open angle glaucoma.[ncbi.nlm.nih.gov]
Skin Lesion
  • Skin lesions, bilateral hilar, and mediastinal lymphadenopathy resolved completely. Cutaneous sarcoidosis is often accompanied by extracutaneous organ involvement.[ncbi.nlm.nih.gov]
  • An improvement of eyelid inflammation was observed while eczematous skin lesions and erosions were resolved within 15 days. After 6 months of continued topical tacrolimus treatment, there was no evidence of atopic dermatitis recurrence.[ncbi.nlm.nih.gov]
Blurred Vision
  • A 24-hour IOP monitoring was performed before and after trabeculectomy on both eyes of 2 JOAG patients-one with transiently blurred vision early in the morning, the other with progression of visual field defect despite apparently well-controlled IOP.[ncbi.nlm.nih.gov]
  • Acute Angle Closure Glaucoma is one of the only types of glaucoma that produce distinct symptoms that include pain, light sensitivity, redness, blurred vision, colored haloes around lights, and nausea or vomiting.[bweyecenter.com]
  • The symptoms of an angle closure attack are red painful eye, blurred vision, nausea, vomiting, and headache. Angle closure is an eye emergency and needs to be treated as soon as possible.[sightmd.com]
  • Symptoms include severe pain and nausea, as well as redness of the eye and blurred vision. If you have these symptoms, you need to seek treatment immediately. Congenital glaucoma.[smartdraw.com]
  • Symptoms include: intense pain, redness, blurred vision, haloes around lights, as well as nausea.[medical-dictionary.thefreedictionary.com]
Arcus Senilis
  • In addition to these features, hypermetropia, deep central corneal opacities, hazy corneal limbus, peripheral scleralization of the cornea and early arcus senilis can also be seen.[ncbi.nlm.nih.gov]
Blue Sclera
  • Ocular findings include blue sclera, low ocular rigidity, and thin corneal thickness. However, there are no documented cases linking OI and primary open angle glaucoma (POAG).[ncbi.nlm.nih.gov]
Waardenburg Syndrome
  • Waardenburg's syndrome is a rare, autosomal dominant disorder, with several clinical signs, each with variable penetrance. We report this case of Waardenburg's syndrome with bilateral open-angle glaucoma with unique gonioscopic findings.[ncbi.nlm.nih.gov]

Workup

The diagnostic workup of patients reporting vision impairment must start with a thorough patient history that can reveal the presence of risk factors and assess the course and progression of symptoms. A positive family history, previous eye-related disorders and potential use of corticosteroids must be noted. A physical examination including visual field examination should be performed. As symptoms may be absent in the early stages, direct ophthalmoscopy is also recommended as a mandatory part of primary practice [3] [4] [5]. A more detailed ophthalmoscopic examination, however, is required to confirm glaucoma and various non-invasive procedures and these may be [4] [5] [7]:

  • Perimetry - Because of its ability to provide a direct view of the patient's visual fields, this computer-based procedure is considered to be the mainstay in diagnosis and management of glaucoma [5].
  • Optical coherence tomography (OCT) - Used to assess the optic nerve head and the retina by creating cross-sectional images [7], OCT is also frequently implemented in glaucoma workup. A more advanced form possessing an increased resolution and faster scanning speed, spectral domain (SD)-OCT, was recently introduced in ophthalmology, providing an even better view of the damaged structures [7].
  • Scanning laser polarimetry and ophthalmoscopy - Measurement of the optic nerve fiber thickness and quantitative detection of viable retinal cells is achieved by these methods, respectively, which may be quite useful when the disease is in its initial stages.
Gliosis
  • […] with the increased incidence of nonrhegmatogenous retinal detachment, and also with strabismus, afferent pupillary defect, visual field defects, presence of hyaloids artery remnants, ciliary body cyst, congenital cataract, lid hemangioma and preretinal gliosis[ncbi.nlm.nih.gov]

Treatment

  • Treatment of atopic eyelid disease with topical tacrolimus, following corticosteroid discontinuation in a steroid responder patient with open-angle glaucoma, seems to be an effective alternative treatment to corticosteroids without the risk of IOP increase[ncbi.nlm.nih.gov]
  • We reviewed the electronic records of 171 patients with POAG under medical hypotensive treatment who underwent 5 consecutive visits 6 months apart before and after medical treatment escalation or additive laser trabeculoplasty.[ncbi.nlm.nih.gov]
  • The elevated intraocular pressures and conjunctival lesions resolved after treatment of the systemic lymphoma with rituximab.[ncbi.nlm.nih.gov]
  • RESULTS: CHM treatment principle and formulae based on pattern differentiation together with approved patent herbal medicines are the main treatments for POAG, and the diagnosis and treatment focusing on blood related patterns is the major domain.[ncbi.nlm.nih.gov]
  • Drugs for glaucoma treatment include prostaglandin analogs, beta blockers, alpha2-adrenergic agonists, and carbonic anhydrase inhibitors. Surgical or laser treatment is indicated if medical management is unsuccessful.[ncbi.nlm.nih.gov]

Prognosis

  • What Is the Prognosis for Primary Open-Angle Glaucoma? The prognosis is generally good for people with primary open-angle glaucoma.[emedicinehealth.com]
  • Prognosis Prognosis is generally good for patients with POAG. With careful follow-up care and compliance with therapy, the vast majority of patients with POAG retain useful vision throughout their lifetime.[emedicine.medscape.com]
  • Prognosis About half of the people stricken by glaucoma are not aware of it. For them, the prognosis is not good, and many of them will become blind. Sight lost due to glaucoma cannot be restored.[medical-dictionary.thefreedictionary.com]

Etiology

  • The present report suggests that visual field defects atypical for glaucoma should be carefully scrutinized for other etiologies.[ncbi.nlm.nih.gov]
  • Etiology The final common pathway for all potential etiologies of POAG is optic nerve head damage. This is thought to be secondary to primarily ganglion cell axon loss, although loss of blood vessels and glial cells has also been observed.[eyewiki.aao.org]
  • Etiology In order to understand the etiology of open-angle glaucoma, it is important to understand the formation and drainage of aqueous humor.[ncbi.nlm.nih.gov]
  • Genetic Etiologies of Glaucoma. Arch Ophthalmol. 2007 Jan;125(1):30-7. DOI: 10.1001/archopht. 125.1.30 9. Yuan L.; Neufeld AH. TNF-α: a potentially neurodestructive cytokine produced by glia in the human glaucomatous optic nerve head.[content.sciendo.com]
  • Future methodology that performs noninvasive, real-time IOP measurements throughout the 24 hours of the day may enable a more complete understanding of the roles that IOP and blood pressure have to the etiology of glaucomatous damage and progression of[emedicine.medscape.com]

Epidemiology

  • Author information 1 Department of Epidemiology, Harvard T. H.[ncbi.nlm.nih.gov]
  • Blasco Ibáñez 15, 46010 Valencia, Spain. carolina.ortega@uv.es. 5 CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Calle Sinesio Delgado, 3, 28029 Madrid, Spain. carolina.ortega@uv.es. 6 Genetic & Molecular Epidemiology[ncbi.nlm.nih.gov]
  • Glaucoma diagnosis was made using optic nerve head retinophotography and International Society for Epidemiologic and Geographical Ophthalmology criteria. sAF was measured with a noninvasive autofluorescence reader in 467 subjects.[ncbi.nlm.nih.gov]
  • Author information 1 Department of Ophthalmology, Erasmus MC, Rotterdam, The Netherlands. 2 Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands. 3 The Rotterdam Eye Hospital, Rotterdam, The Netherlands. 4 Department of Clinical Genetics[ncbi.nlm.nih.gov]
  • Ear Infirmary, Harvard Medical School, Boston, Massachusetts, United States. 6 Department of Ophthalmology, Hamilton Glaucoma Center and Shiley Eye Institute, University of California at San Diego, La Jolla, California, United States. 7 Department of Epidemiology[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • These differences might provide comparative insight into the pathophysiology of these two diseases.[ncbi.nlm.nih.gov]
  • BACKGROUND: The pathophysiological changes occurring in the trabecular meshwork in primary open angle glaucoma are poorly understood, but are thought to include increased extracellular matrix deposition, trabecular meshwork cell apoptosis, inflammation[ncbi.nlm.nih.gov]
  • This finding may provide insight into the pathophysiology of angle closure and provide assistance in future diagnosis, prevention, and management of the angle-closure spectrum of disorders. Copyright 2017 Elsevier Inc. All rights reserved.[ncbi.nlm.nih.gov]
  • Pathophysiology The primary problem in glaucoma is disease of the optic nerve. The pathophysiology is not fully understood but there is a progressive loss of retinal ganglion cells and their axons.[patient.info]
  • Current concepts on primary open-angle glaucoma genetics: a contribution to disease pathophysiology and future treatment. Eye. 2012 Mar;26(3):355-69. DOI: 10.1038/eye.2011.309 8. Wiggs JL. Genetic Etiologies of Glaucoma.[content.sciendo.com]

Prevention

  • Author information 1 Genetic & Molecular Epidemiology Unit, Department of Preventive Medicine & Public Health, School of Medicine, University of Valencia, Avenida Vicente Blasco Ibáñez 15, 46010 Valencia, Spain. vicente.zanon-moreno@uv.es. 2 CIBER Fisiopatología[ncbi.nlm.nih.gov]
  • Early detection prevents major vision loss While you can’t prevent glaucoma, you can prevent major vision loss from this disease with early detection and treatment. Vision Loss from Glaucoma[nweyes.com]
  • Systemic treatment alone may be adequate to prevent progression of a glaucomatous diseased state.[ncbi.nlm.nih.gov]
  • Prevention Is Easy When it comes to preventing glaucoma, the best thing you can do is get regular eye examinations and glaucoma screenings from Eye and Lasik Center.[eyeandlasik.com]
  • Sufficiently lowering IOP before surgery and gradually decreasing IOP during surgery may prevent ODR from occurring.[ncbi.nlm.nih.gov]

References

Article

  1. Weinreb RN, Khaw PT. Primary open-angle glaucoma. Lancet. 2004;363:1711–1720.
  2. Beidoe G, Mousa SA. Current primary open-angle glaucoma treatments and future directions. Clin Ophthalmol. 2012;6:1699-1707.
  3. Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J; 2011.
  4. Weinreb RN, Aung T, Medeiros FA. The pathophysiology and treatment of glaucoma: a review. JAMA. 2014;14;311(18):1901-1111.
  5. Distelhorst JS, Hughes GM. Open-Angle Glaucoma. Am Fam Physician. 2003;67:1937–44.
  6. Hu CX, Zangalli C, Hsieh M, et al. What Do Patients With Glaucoma See? Visual Symptoms Reported by Patients With Glaucoma. Am J Med Sci. 2014;348(5):403-409.
  7. Bussel II, Wollstein G, Schuman JS. OCT for glaucoma diagnosis, screening and detection of glaucoma progression. Br J Ophthalmol. 2014;98(2):ii15-ii19.

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Last updated: 2019-07-11 21:18