Glaucoma

Aka: Glaucoma, Increased Intraocular Pressure

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II. Definitions

  1. Glaucoma
    1. Increased Intraocular Pressure AND Optic Nerve injury
    2. High risk of blindness if untreated (acuity <20/200)

III. Epidemiology

  1. Within top 3 causes of blindness in U.S.
    1. Leading cause of blindness in non-white
  2. U.S. Prevalence: 2 Million
    1. Only 50% are estimated to now be under treatment
    2. 120,000 are blind due to Glaucoma
    3. Highest risk groups for Glaucoma-related blindness in Blacks and Hispanics
  3. World Prevalence: 80 Million (estimated by 2020)
    1. Bilateral blindness due to Glaucoma estimated at 11 million worldwide by 2020

IV. Pathophysiology

  1. Elevated Intraocular Pressure (IOP)
    1. Increased production of Aqueous Humor by ciliary body
      1. Aqueous Humor is typically produced at 2 ul/min
    2. Increased outflow resistance at Aqueous Outflow Angle
      1. Trabecular meshwork
      2. Canal of Schlemm
  2. Progressive changes in optic disc
    1. Nerve damage related to increased IOP is variable
      1. Glaucoma suspects (66% of those with high IOP)
        1. No damage despite high Intraocular Pressure (>21)
        2. Optic Nerve injury rate in suspects: 1% per year
      2. Normal-pressure Glaucoma (15% of Glaucoma patients)
        1. Normal Intraocular Pressure (21 mmHg or less)
        2. Glaucoma-related Optic Nerve damage
    2. Progressive Glaucomatous cupping at the optic disc
      1. IOP collapses Optic Nerve head structural support
      2. Axons destroyed by mechanical compression
  3. Peripheral Visual Field loss
    1. Open Angle Glaucoma: Slowly progressive
    2. Narrow Angle Glaucoma: Rapid Vision Loss

V. Types

  1. Primary Glaucoma
    1. Open Angle Glaucoma (89% of cases)
      1. Outflow blocked by microscopic outflow changes
      2. Results in progressive peripheral Vision Loss
      3. Usually asymptomatic until 40% of nerve loss
    2. Narrow Angle Glaucoma (11% of cases)
      1. Outflow tract blocked by base of iris
      2. Permanent Vision Loss may occur in hours
      3. Presents as acute painful Red Eye with Vomiting
  2. Secondary Glaucoma
    1. Medications that increase IOP in those predisposed
      1. Corticosteroids (Systemic and Topical)
        1. Reversible
      2. Mild Adrenergic or Anticholinergic Medications
        1. Examples
          1. Cold Medications
          2. Antidepressants
          3. Antidiarrheals
        2. Effect: Dilate Pupil
          1. Theoretically worsen angle closure Glaucoma
          2. Not contraindicated in Glaucoma

VI. Resources

  1. Aging Eye Glaucomatrac (Glaucoma Management Tracking)
    1. http://www.agingeye.net/glaucomacharting.index
  2. Aging Eye Glaucoma Video
    1. http://www.agingeye.net/mainnews/video.php

VII. References

  1. Alward (1998) N Engl J Med 339:1298-307 [PubMed]
  2. Distelhorst (2003) Am Fam Physician 67(9):1937-50 [PubMed]
  3. Gupta (2016) Am Fam Physician 93(8):668-74 [PubMed]
  4. Infeld (1998) Postgrad Med 74:709-15 [PubMed]

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Related Studies

Ontology: Glaucoma (C0017601)

Definition (MEDLINEPLUS)

Glaucoma is a group of diseases that can damage the eye's optic nerve. It is a leading cause of blindness in the United States. It usually happens when the fluid pressure inside the eyes slowly rises, damaging the optic nerve. Often there are no symptoms at first. Without treatment, people with glaucoma will slowly lose their peripheral, or side vision. They seem to be looking through a tunnel. Over time, straight-ahead vision may decrease until no vision remains.

A comprehensive eye exam can tell if you have glaucoma. People at risk should get eye exams at least every two years. They include

  • African Americans over age 40
  • People over age 60, especially Mexican Americans
  • People with a family history of glaucoma

There is no cure, but glaucoma can usually be controlled. Early treatment can help protect your eyes against vision loss. Treatments usually include prescription eyedrops and/or surgery.

NIH: National Eye Institute
Definition (MSHCZE) Zelený zákal. Onemocnění charakterizované zvýšeným nitroočním tlakem a následnými změnami vnitřních částí oka a poškozením zrakového nervu, které vede k poruchám vidění. G. postihuje až 2% populace středního a vyššího věku a v rozvinutých zemích patří k nejč. příčinám slepoty. Objeví-li se na oku zdravém, jde o primární g., jeho příčina není zcela jasná, je-li důsledkem jiného očního onemocnění (oční záněty, úraz aj.), jde o g. sekundární. Podstatou většiny druhů g. je zvýšení tlaku komorové vody v oku (zvýšená tvorba či poruchy jejího odtoku). Tento tlak lze při odborném očním vyšetření změřit. Akutní g. (vzácnější) se projevuje akutními záchvaty silné bolesti oka a hlavy, světloplachostí, zarudnutím oka, viděním barevných kruhů kolem zdrojů světla a různě velkou poruchou vidění (např. mlhavé vidění), někdy i nevolností a zvracením. Zrak se vlivem záchvatů zhoršuje, k čemuž může docházet postupně – a zákeřně – i bez akutních záchvatů (u chronického g. častější). Podstatou léčby je snižování nitroočního tlaku. Používají se oční kapky pilokarpin, betablokátory, popř. některé vnitřně podané léky snižující tvorbu komorové vody. V některých případech se používá laser nebo se provádí operace. Včasně zahájená a pečlivě prováděná léčba umožní nemoc zastavit a zabránit tak těžkému porušení zraku či dokonce slepotě. Vzniklá poškození však již nelze odstranit, proto je důležitá včasná diagnóza a pečlivé dodržování léčby. Některé vnitřně podané léky (atropin, spasmolytika) mohou u nemocného glaukomem vyvolat záchvat; řec. glaukos modrozelený. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ )
Definition (NCI_CTCAE) A disorder characterized by an increase in pressure in the eyeball due to obstruction of the aqueous humor outflow.
Definition (NCI_NCI-GLOSS) A condition in which there is a build-up of fluid in the eye, which presses on the retina and the optic nerve. The retina is the layer of nerve tissue inside the eye that senses light and sends images along the optic nerve to the brain. Glaucoma can damage the optic nerve and cause loss of vision or blindness.
Definition (NCI) Increased pressure in the eyeball due to obstruction of the outflow of aqueous humor.
Definition (MSH) An ocular disease, occurring in many forms, having as its primary characteristics an unstable or a sustained increase in the intraocular pressure which the eye cannot withstand without damage to its structure or impairment of its function. The consequences of the increased pressure may be manifested in a variety of symptoms, depending upon type and severity, such as excavation of the optic disk, hardness of the eyeball, corneal anesthesia, reduced visual acuity, seeing of colored halos around lights, disturbed dark adaptation, visual field defects, and headaches. (Dictionary of Visual Science, 4th ed)
Definition (CSP) group of diseases characterized by increased intraocular pressure resulting in damage to the optic nerve and retinal nerve fibers.
Concepts Disease or Syndrome (T047)
MSH D005901
ICD9 365.9, 365
ICD10 H40 , H40-H42.9, H40.9, H40-H42
SnomedCT 155120009, 194631001, 193569008, 23986001
LNC MTHU020819, LA16302-4
English Glaucomas, Glaucoma, Unspecified glaucoma, Glaucoma NOS, Glaucoma, unspecified, glaucoma (diagnosis), glaucoma, Glaucoma [Disease/Finding], glaucomas, Glaucoma (H40-H42), Glaucoma NOS (disorder), GLAUCOMA, Glaucoma (disorder), Glaucoma, NOS
French GLAUCOME, Glaucome SAI, Glaucome, non précisé, Glaucome non précisé, Glaucome
Portuguese GLAUCOMA, Glaucoma NE, Glaucoma
Spanish GLAUCOMA, Glaucoma no especificado, Glaucoma NEOM, glaucoma, SAI (trastorno), glaucoma, SAI, glaucoma (trastorno), glaucoma, Glaucoma
German GLAUKOM, Glaukom, unspezifisch, Glaukom NNB, unspezifisches Glaukom, Glaukom, nicht naeher bezeichnet, Glaukom, Star, grüner
Dutch glaucoom NAO, glaucoom, niet-gespecificeerd, niet-gespecificeerd glaucoom, Glaucoom, niet gespecificeerd, glaucoom, Glaucoom
Italian Glaucoma NAS, Glaucoma non specificato, Glaucoma
Japanese 緑内障ＮＯＳ, 緑内障, 詳細不明の緑内障, 緑内障、詳細不明, ｼｮｳｻｲﾌﾒｲﾉﾘｮｸﾅｲｼｮｳ, ﾘｮｸﾅｲｼｮｳNOS, ﾘｮｸﾅｲｼｮｳｼｮｳｻｲﾌﾒｲ, ﾘｮｸﾅｲｼｮｳ
Swedish Grön starr
Czech zelený zákal oční, glaukom, Glaukom, Blíže neurčený glaukom, Glaukom NOS, zelený zákal
Finnish Glaukooma
Russian GLAUKOMA, ГЛАУКОМА
Korean 상세불명의 녹내장, 녹내장
Croatian GLAUKOM
Polish Jaskra
Hungarian Glaucoma k.m.n., Glaucoma, nem meghatározott, Glaucoma, Nem meghatározott glaucoma
Norwegian Glaukom, Grønn stær
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Raised intraocular pressure (C0234708)

Concepts Finding (T033)
SnomedCT 112222000, 155121008, 267721003, 193536008
English INTRAOCULAR PRESSURE INCREASED, Increased intraocular pressure, OCULAR TENSION INCREASED, high intraocular pressure, intraocular pressure was increased, Intraocular pressure high, Intraocular pressure increased, Pressure intraocular increased, Ocular tension increased, Tension ocular increased, Intraocular pressure raised, Raised IOP, increased intraocular pressure (physical finding), increased intraocular pressure, increase intraocular pressure, raised intraocular pressure, intraocular pressure increase, Raised intra-ocular pressure, Increased intra-ocular press., IOP increased, Elevated intraocular pressure, Raised intraocular pressure, Raised intraocular pressure (finding), intraocular; increased pressure
Italian Pressione intraoculare aumentata, Pressione endooculare aumentata, Pressione intraoculare elevata, Tensione oculare aumentata, Pressione oculare aumentata
Dutch spanning oculair verhoogd, intraoculaire druk gestegen, verhoogde intraoculaire druk, intraoculaire druk hoog, IOD verhoogd, gestegen IOP, druk intraoculair verhoogd, oogdruk verhoogd, intraoculair; drukverhoging, intraoculaire druk verhoogd
French Tension oculaire augmentée, Elévation de la pression intraoculaire, Elévation de la PIO, Pression intraoculaire augmentée, PIO (pression intra-oculaire) augmentée, Pression intraoculaire élevée, AUGM PRESSION INTRAOCULAIRE, ELEVATION DE LA TENSION OCULAIRE, Pression intra-oculaire augmentée
German intraokulaerer Druck hoch, Druck intrakraniell erhoeht, intraokulaerer Druck gestiegen, Augenspannung erhoeht, erhoehter intraokulaerer Druck, Spannung Auge erhoeht, gestiegener intraokulaerer Druck, AUGENDRUCKERHOEHUNG, DRUCKSTEIGERUNG INTRAOKULAER, intraokulaerer Druck erhoeht
Portuguese Tensão intra-ocular elevada, Tensão intra-ocular aumentada, Pressão intra-ocular aumentada, Tensão intra-ocular alta, Pressão intraocular aumentada, PIO elevada, PRESSAO INTRAOCULAR AUMENTADA, TENSAO OCULAR AUMENTADA, Tensão intraocular aumentada
Spanish Presión intraocular alta, PIO aumentada, Tensión ocular aumentada, Presión intraocular elevada, Presión ocular aumentada, PIO elevada, PRESION INTRAOCULAR AUMENTADA, TENSION INTRAOCULAR AUMENTADA, aumento de la presión intraocular, presión intraocular aumentada (hallazgo), presión intraocular aumentada, presión intraocular elevada, Presión intraocular aumentada
Japanese ＩＯＰ上昇, 眼圧上昇, 眼圧高値, IOPｼﾞｮｳｼｮｳ, ｶﾞﾝｱﾂｼﾞｮｳｼｮｳ, ｶﾞﾝｱﾂｺｳﾁ
Czech Nitrooční tlak zvýšený, Nitrooční tlak vysoký, Zvýšený NOT, Oční tlak zvýšený, NOT zvýšený, Zvýšený nitrooční tlak
Hungarian Szembelnyomás magas, Emelkedett intraokuláris nyomás, Szembelnyomás emelkedett, Intraocularis nyomás megemelkedett, Szembelnyomás megemelkedett, Intraocularis nyomás emelkedett, IOP emelkedett
Derived from the NIH UMLS (Unified Medical Language System)

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