1- acute angle closure glaucoma:
* Occurs in susceptible patients (hyperopic)
* The pupillary block occurs during mydriasis triggered by stress, the transition to the dark, general anesthesia, eye drops mydriatic, or para sympatholytic sympathomimetic drugs.
* The decrease in visual acuity and total mass;
* Reduced transparency of the cornea (corneal edema)
* The pupil is semi-aréflectique mydriasis with abolition of the direct RPM and con-sensual of the affected eye.
* The IOP is still> 50 mmHg
* Adelphe Eye (always): ant room. and narrow anterior chamber angle
* The disease progresses rapidly within hours to blindness.
* Treatment: acetazolamide (Diamox®) IV mannitol + 25% + beta-blocker eye drops (timolol => miosis)
* As soon as the crisis is under control -> laser iridotomy on both eyes
2- Chronic Glaucoma:
* Also known as primary open-angle glaucoma; it is a progressive and asymptomatic optic neuropathy (diagnosis during a systematic review)
* Frequent pathology that affects 1% of the population over 40 years
* Characterized by progressive destruction of the optic nerve under the influence of a number of risk factors, the most important is the intraocular pressure (> 21)
* The 3 major signs of the disease are:
– The pathological increase in intraocular pressure (fickle)
– Enlargement of the excavation of the papilla
– Alterations of the visual field
* BUT: ocular hypertension may be transient or absent clinical picture
* In glaucoma, the increased intraocular pressure is related to the progressive degeneration of the trabecular meshwork
* Other risk factors: heredity; age> 40 years; corticosteroids; low blood pressure; diabetes mellitus; vasospasm (Raynaud, migraine).
* Eye examination: visual acuity preserved; calm and white eye; a deep anterior chamber; reactive pupil; open angle; optical disc excavated (by scarcity of optic nerves) in the temporal edge at the start (ratio cup / disc> 0.3; neural rim decreases).
* Visual field: arcuate Bjerrum scotoma; nasal projection
* In untreated glaucoma evolves into a progressive and irreversible degradation of the visual field (tubular field);reduced to a mere temporal crescent and a central island of vision; -> Visual acuity decreases rapidly.
* Medical treatment is prescribed for life; the beta-blocker eye drops is prescribed as first line.
* Instrumentation therapy: laser trabeculoplasty if resistance drops
* Surgical treatment: trabeculectomy