By George A. Cioffi, MD
This part underwent significant revision for the 2008-2009 edition.Topics mentioned comprise the epidemiologic points of glaucoma; hereditary and genetic elements; intraocular strain and aqueous humor dynamics; medical review; scientific administration of and surgical treatment for glaucoma. This variation comprises up-to-date tables and revised pictures, in addition to a variety of new photographs illustrating either illness entities and surgical thoughts.
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Additional info for 2008-2009 Basic and Clinical Science Course: Section 10: Glaucoma (Basic and Clinical Science Course 2008-2009)
0: The iris is against the trabecular meshwork. Angle closure is present. The Spaethgonioscopicgrading systemexpands this system to include a description of the peripheral iris contour, the insertion of the iris root, and the effects of dynamic gonioscopy on the angle configuration (Fig 3-4). Ordinarily, Schlemm's canal is invisible by gonioscopy. Occasionally during gonioscopy, at times in normal eyes, blood refluxes into Schlemm's canal, where it is seen as a faint red line in the posterior portion of the trabecular meshwork (Fig 3-5).
Other conditions that cause increased anterior chamber angle pigmentation include malignant melanoma, trauma, surgery, inflammation, angle closure, and hyphema. Posttraumatic angle recessionmay be associated with monocular open-angle glaucoma. The gonioscopic criteria for diagnosing angle recession include . an abnormally wide ciliary body band (Fig 3-8) . increased prominence of the scleral spur . torn iris processes . marked variation of ciliary face width and angle depth in different quadrants of the same eye In evaluating for angle recession, it is helpful to compare one part of the angle to other areas in the same eye or to the same area in the fellow eye.
Glaucoma Table 2-2 Factors That Affect Intraocular Pressure Factors that may increase intraocular pressure Elevated episcleral venous pressure Valsalva maneuver Breath holding Playing a wind instrument Wearing a tight collar or tight necktie Bending over or being in a supine position Elevated central venous pressure Orbital venous outflow obstruction Intubation Pressure on the eye Blepharospasm Squeezing and crying, especially in young children Elevated body temperature: associated with increased Hormonal influences Hypothyroidism Thyroid ophthalmitis Drugs unrelated to therapy Lysergic acid diethylamide (LSD) Topiramate (Topamax) Corticosteroids Anticholinergics: may precipitate angle closure aqueous humor production Factors that may decrease intraocular pressure Aerobic exercise Anesthetic drugs Ketamine Depolarizing muscle relaxants such as succinylcholine Metabolic or respiratory acidosis: decreases aqueous humor production Hormonal influences Pregnancy Drugs unrelated to therapy Alcohol consumption Heroin Marijuana (cannabis) Diurnal Variation In normal individuals, lOP varies 2-6 mm Hg over a 24-hour period, as aqueous humor production and outflow change.