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;

digestive symptoms

* 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

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