Ophthalmology · MU Sofia

80. Secondary glaucoma - open and closed angle, pathogenesis, clinical findings and treatment

Covers secondary glaucoma as a group of conditions where a raised intraocular pressure arises from an ocular or systemic disease, classified by mechanism (open or closed angle) and by underlying cause. It walks through lens-induced forms (phacomorphic and phacolytic), uveitic and post-inflammatory glaucoma, pigmentary and neovascular glaucoma, tumour-related and steroid-induced glaucoma, ciliary block, and haemorrhage-related types, noting treatment for each. Congenital developmental abnormalities are touched on briefly at the end.

Inside: 1 section · 16 flashcards · 4 min

Topic 80 of 91 in the MU Sofia syllabus for Ophthalmology (Medicine, Year 4). The free AceMed note covers it in 1 section, about 527 words (4 min of reading), with 16 flashcards.

In this note

  1. Secondary and congenital glaucoma Topic 54

Secondary and congenital glaucoma Topic 54

Secondary

=not a disease but a group of diseases where increase In IOP is due to a ocular o systemic disease

Can be classified into

1)The mechanism of rise in IOP→ secondary OPG and secondary ACG

2)The causative primary disease

Lens induced (phacogenic), Inflammatory glaucoma, Pigmentary glaucoma, Neovascular glaucoma, Traumatic, association with intraocular tumour

Lens induced

= increase in IOP due to lens disorders

A) phacomorphic – included Acute closed angle types

1) Swollen lens (either due to rapid maturation of cataract or rupture of capsule)

2) dislocation of lens or spherophakia (congential small speherical lens)

Both of which obstruct and thsus are angle-closure types

Very similar clinical presentation to Primary angle-closure + CATARCT

Treatment : medical like in other types + CATARCT EXTRACTION

B)Phacolytic

-involve the lens but OPEN ANGLE caused by clogging of trabecular meshwork by lens proteins &macrophages and this leakage occurs due to intact capsule (morganian)

-removal of hypermature cataractous lens + medical therapy

Glaucoma due to uveitis

-rise of IOP due to inflame. Of Uveal tissue (iridocyclitis) + ocular inflame. (keratitis &scleritis)

-acute inflame. Of anterior Uveal tract leading to trabecular clogging (either via inflammation of the trabecular itself or by inflammatory cells)

Treatment

-local steroids + hyperosmotic agents + beta-blocker to control IOP

Post inflammatory glaucoma

-raise of IOP due to after effects of iridocyclitis

Such as pupillary block due to annular synechiae , angle closure due to iris bombe formation or inflammatory debris build up in the angle or even open angle as trabecular scarring and obstruction may be the cause

Pigmentary glaucoma

-Open angle type, but clogging of meshwork by pigment particles (pigment dispersion syndrome) ; treated like Primary open angle glycoma

Neovascular glaucoma

-new formation of vascular membrane at angle of anterior chamber which develops after retinal Ischaemia caused by and usually of iris (rubeosis irididis)

Diabetic retinopathy, central retinal vein occlusion etc.

Different mechanism: open angle ; formation of membrane blocking meshwork

Angle closure → contracture of neovascular membrane closes the angle

Treatment→ Panretinal photocoagulation (prevent neovascularisation) + filtration surgery and artificial filtration shut (Seton operation)

Glaucoma due to Intraocular tumours

=Increase in IOP because of malignant melanoma of Iris choroid ciliary body or retinoblastoma ( thereby block meshwork, neovasc at angle. Venous stasis, angle closure due to displacement of iris-lens diaphragm as tumour pushes)

Steroid induced glaucoma

-usually due to topical/systemic use of steroid (in treatment against bacteria)

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