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Thursday, 28 November 2013

Glaucoma – The Types and Symptoms

Glaucoma is a medical condition of an eye disease as result of the damage of the nerve of eye’s optic over time. If left untreated, it can lead to permanently vision impair and blindness.
I. Types of glaucoma(a)
There are several types of glaucoma. The two main types are (Chronically)open-angle and (Acutely)angle-closure both as a result of increase of intraocular pressure (IOP), or pressure inside the eye.
A. Open-Angle Glaucoma affects about three million Americans.
Open-angle glaucoma is the most common form of glaucoma. According to the statistic, it effects over 90% in all glaucoma cases:
1. Open-Angle Glaucoma caused by the slow progesion of clogging of the drainage canals, resulting in increased intraocular pressure (IOP). In the study to investigate risk factors for primary open-angle glaucoma (POAG) and pseudoexfoliative glaucoma (PEXG), showed that intraocular pressure (IOP) was the only factor associated with both POAG and PEXG, whereas moderate-to-high myopia showed borderline significance in both. Vascular systemic diseases and their treatment were associated only with POAG. The implications of these differences for the pathogenesis between the 2 common types of OAG should be explored further(1).
2. Open-Angle Glaucoma as a result of the area  between the iris and cornea (The angle) widen.
3. Open-Angle Glaucoma develops slowly and is a lifelong condition
In the 6-year follow-up study of 118 control patients: 46 with high-tension glaucoma (HTG), 57 with normal-tension glaucoma (NTG), and 15 with pseudoexfoliation glaucoma (PEXG)., the median untreated rate of progression corresponded to advancing from normal visual function to blindness in approximately 70 years, whereas on the basis of the mean rate, visual function would show the same deterioration in approximately 25 years. Large differences existed among patients and different glaucoma types, with PEXG progressing considerably faster than HTG, and NTG progressing at the lowest rate(2).
4.  Symptoms and Damage
The symptoms of gradually progressive visual field loss, and optic nerve changes (increased cup-to-disc ratio on fundoscopic examination) has not been noticed in the early stage of the diseases.
There is a report of 3 cases of ocular injuries were described in young patients, due to accidental fall of durian fruit on the forehead and face, while they were taking rest/sleeping /playing under the durian tree. The ocular injuries observed were lacerating injury of cornea with iris incarceration, hyphema, superficial penetrating injury of sclera and angle recession glaucoma in the right eye of first patient; lacerating injury of cornea with iris prolapse in the left eye of second patient; subconjunctival haemorrhage, traumatic mydriasis and superficial penetrating injury of sclera, commotion retinopathy and macular edema in the left eye of third patient(3).
B. Angle-Closure Glaucoma
Angle-closure glaucoma is a less common form of glaucoma
1. Caused by Sudden rise in intraocular pressure due to blockage of drainage canals and Develops very quickly
Psychotropic agents may frequently be associated with ocular adverse effects, which include angle-closure glaucoma. There is a report of a case of pseudoexfoliation glaucoma in which intraocular pressure (IOP) increased within hours after carbamazepine and gabapentin intake, with no observable evidence of any angle closure(4)
2. Caused by a closed or narrow angle between the iris and cornea
In the study of 5,308 respondents to the Baltimore Eye Survey, a cross-sectional, population-based survey conducted in a multiracial urban community, of that 4,870 subjects whose eyes were dilated on screening examination, none developed acute angle-closure glaucoma. However, 38 patients of the 1,770 who were referred for definitive eye examination were judged to have occludable angles on the basis of gonioscopic methods(5).
3. Symptoms and damage that are usually very noticeable
Paience with Angle-closure glaucoma may be experience the symptoms of sudden ocular pain, seeing halos around lights, red eye, very high intraocular pressure (>30 mmHg), nausea and vomiting, suddenly decreased vision, and a fixed, mid-dilated pupil, etc. as a result of damage due to medication, etc.
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