Information about Glaucoma:
In this video I explained how to recognize glaucoma and how to treat it. I specifically decided not to include many illustrations because glaucoma itself doesn’t always cause symptoms. In fact it is often refered to as the silent killer of sight because of that. So here we discussed some medications such as azetolamide and pilocarpine drops. We also discussed some surgical options such as goniotomy and trabeculectomy as well as the laser treatment options for glaucoma. This is a really interesting topic but I struggled with how to present it simply because of the lack of symptoms. There is an acute form of glaucoma the acute angle-closure glaucoma, and that form does have eye redness and headache as well as the eye pain as it’s defining combination of symptoms.
Posted by Symptomsky – Medical Chat & USMLE-prep on Monday, October 9, 2023
Glaucoma – Eye Redness and Pain are Not Always Present
Glaucoma is a dangerous condition in which the optic nerve is damaged due to increased intraocular pressure. Before explaining its main cause, let’s talk about intraocular pressure. Our eye is filled with fluid called the aqueous humor, which has several functions, including the maintenance of normal ocular pressure. Whenever the production of aqueous humor is increased from its normal 2 to 3 microliters per minute or decreases its drainage in trabecular meshwork, it leads to an increase in the volume of fluid and intraocular pressure. This increased pressure causes damage to the retinal artery and optic nerve.
Talking about its epidemiology, Glaucoma is associated with old age, a family history of glaucoma, and certain medical conditions or medications like antimuscarinic and steroidal drugs. According to research, there is 10 percent of the population over 40 years of age.
Coming to its symptoms, Glaucoma is known as the silent thief of eyesight because there are no symptoms at the start. Late symptoms appear in the form of peripheral visual field defects, especially at the nose side, vision loss, eye pain or pressure, low or blurred vision, halos around lights, nausea, vomiting, and red eyes. Differential diagnosis is important to differentiate between open-angle glaucoma and angle-closure glaucoma. If the disease is unilateral, i.e., affecting one eye, it is most likely to be acute angle-closure glaucoma. There are certain other diseases like ocular hypertension, diabetic retinopathy, and papilledema that have some similar symptoms with glaucoma.
Therapy options are present. We reduce the production of aqueous humor or increase its drainage using acetazolamide or local pilocarpine drops. Surgical treatments include Trabeculectomy, Goniotomy, laser therapy, and Laser iridotomy in angle-closure glaucoma. For acute glaucoma, immediate ophthalmological treatment is required to avoid irreversible damage to the optic nerve, which results in the loss of normal vision.
In this video I described why open-angle glaucoma is hard to recognize. I had to illustrate it but how? It usually causes no symptoms at all until the damage is very severe. The symptoms at the later stage of life are peripheral vison loss and halos around lights but this type of glaucoma doesn’t cause the redness and pain the way the acute one does. So this was my best attempt to illustrate it and explain it. If you have any suggestions, let me know..
Posted by Symptomsky – Medical Chat & USMLE-prep on Wednesday, October 11, 2023
Open-angle Glaucoma – Silent Killer of Sight – USMLE 1
Among the various types of glaucoma, open angle glaucoma is the most common, accounting, for over 90% of all case. this article will shed light on open angle glaucoma, explaining its causes, symptoms and treatment while also touching on other glaucoma variants and the important of early diagnosis.
Open angle glaucoma manifests optic nerve damage accompanied by loss of peripheral vision. The primary factor contributing to elevated intraocular pressure in tis condition is the blockage of the trabecular meshwork. while it is essential to note that open angle glaucoma is often associated with factors like aging, race (predominantly affecting African, Hispanic and Asian population), Family history, hypertension and diabetes mellitus, these are risk factor rather than direct cause. it’s entirely possible for patient to suffer from open angle glaucoma without any of these risk factor.
Identifying open angle glaucoma can be challenging as its symptoms may not always be present in its early stages, patient may not notice any issue with their vision. however some common sign includes 1. seeing halos around light 2. blurred vision 3. tunnel vision 4. Difficulty adjusting low light 5. frequent changes in eye glasses prescription.
To comprеhеnd how opеn-anglе glaucoma occurs, wе must look at thе trabеcular mеshwork, a vital componеnt in rеgulating intraocular prеssurе. Aquеous humor, thе fluid producеd in thе еyе, flows bеtwееn thе iris and thе lеns bеforе еntеring thе antеrior chambеr. In thе antеrior chambеr, it can bе drainеd into thе trabеcular mеshwork. Elеvatеd production of aquеous fluid or a blockеd trabеcular mеshwork can lеad to incrеasеd intraocular prеssurе, which in turn, damagеs thе optic nеrvе.
So that’s why here, in the differential diagnosis of open angle glaucoma, we have angle closure glaucoma. We also have normal tension glaucoma. This is optic nerve damage without an increase of intraocular pressure. So the intraocular pressure is normal, but we still have optic nerve damage. Other things can damage the optic nerve as well, such as ocular hypertension ischemic, optic neuropathy, and optic neuritis, an inflammation of the optic nerve the damage of the optic nerve happens over a longer period of time.
In order to increase the outflow of the aqueous humor, we can reduce the production of aqueous humor, we can use beta blockers like Tymolol. If medication doesn’t help the patient with open angle glaucoma, we can use surgical treatments such as trabeculectomy and tube shunt implantation.
Acute Angle-Closure Glaucoma – Eye Redness and Pain and Vision Loss – USMLE 1 Differential Diagnosis