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1. Pathogenesis

PRIMARY ANGLE-CLOSURE GLAUCOMA. 1. Pathogenesis. 2. Classification. 3. Intermittent. 4. Acute congestive. 5. Post congestive. 6. Chronic. Anatomical predispositions. Shallow anterior chamber. Convex iris-lens diaphragm. Narrow entrance to chamber angle. Pupil block.

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1. Pathogenesis

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  1. PRIMARY ANGLE-CLOSURE GLAUCOMA 1. Pathogenesis 2. Classification 3. Intermittent 4. Acute congestive 5. Post congestive 6. Chronic

  2. Anatomical predispositions • Shallow anterior • chamber • Convex iris-lens • diaphragm • Narrow entrance to • chamber angle

  3. Pupil block • Increase in physiological • pupil block • Dilatation of pupil renders peripheral • iris more flaccid • Increased pressure in posterior • chamber causes iris bombe • Angle obstructed by peripheral iris • and rise in IOP

  4. Classification 1. Latent-asymptomatic • IOP may remain normal • May progress to subacute, acute or chronic • angle closure 2. Subacute- intermittentangle closure • May develop acute or chronic angle closure 3. Acute • Congestive - sudden total angle closure • Postcongestive - follows acute attack 4. Chronic - ‘creeping or latent’ angle closure • Follows intermittent angle closure 5. Absolute • No PL following acute attack

  5. Intermittent angle-closure glaucoma Signs Treatment • Epithelial oedema and closed angle • during attack • Treatment - bilateral YAG laser • iridotomy

  6. Acute congestive angle-closure glaucoma Signs • Ciliary injection • Complete angle closure • (Shaffer grade 0) • Severe corneal oedema • Shallow anterior • chamber • Dilated, unreactive, • vertically oval pupil

  7. Treatment of Acute Congestive Angle-Closure Glaucoma 1. Acetazolamide 500 mg i.v. 2. Hyperosmotic agents - if appropriate • Oral glycerol 1-1.5 g/kg of 50% solution in lemon juice • Intravenous mannitol 2g/kg of 20% solution 3. Topical therapy • Pilocarpine 2% to both eyes • Beta-blockers • Steroids 4. YAG laser iridotomy • To both eyes when cornea is clear

  8. Signs of postcongestive angle-closure glaucoma • Folds in Descemet • membrane • Stromal iris atrophy with • spiral-like configuration • Posterior synechiae • Fixed dilated pupil • Fine pigment on iris • Glaukomflecken

  9. Chronic angle-closure glaucoma Signs • Easily missed unless routine • gonioscopy performed • Similar to POAG with • cupping and field loss • Variable amount of angle closure

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