Secondary Forms of Open Angle Glaucoma
Pigmentary Glaucoma
Pigmentary Glaucoma also called Pigmentary Deposition Syndrome, is a secondary form of open-angle glaucoma. There is an abnormal increase in the deposition of pigment in the anterior portion of the eye, thereby reducing the drainage of the eye system. People in their twenties to forties with a history of primary open-angle glaucoma may be more susceptible. This disease affects men more than women and those that are nearsighted. For the diagnosis of pigmentary glaucoma, there must be damage to the optic nerve and loss of visual fields. The concave shape of the iris leads to rubbing of the iris on the lens. This leads to the release of pigment, which obstructs the eye’s drainage system. This in turn raises the pressure inside the eye. Diagnosis requires a gonioscopy to determine the extent of the increased pigmentation. An ultrasound biomicroscopy may be needed to evaluate the shape of the iris. Pigmentary glaucoma is usually treated by Argon Laser Trabeculoplasty.
Pseudoexfoliation Glaucoma
Pseudoexfoliation Glaucoma is the second most common form of glaucoma in the world. It is more common in some cultures than other. For instance, it is more commonly seen in Scandinavian people, Mediterranean people, Russians, and Indians to name a few. This type of glaucoma affects women more often than men and is usually seen in people in their fifties. Pseudoexfoliation glaucoma has a fast disease progression and higher eye pressure than other forms of open-angle glaucoma. The disease results from proteins and pigment depositing into an inner eye membrane. Over time the membrane compresses a drainage canal of the eye, leading to increased eye pressure. The presentation is usually unilateral and with white flakes on the lens, iris, and other structures of the eye. A slit-lamp exam will be done to to check for presence of flakes in the eye. Also, an Optical Coherence Test to check the optic nerve fiber and Heidelberg Retina Tomography to measure the optic disc. Treatment is done with an argon laser trabeculoplasty and eye pressure reducing medications.
Traumatic Glaucoma
Traumatic Glaucoma is a broad spectrum of pathologies that cause open-angle glaucoma. Hyphema is one of these forms. It is caused by either blunt trauma to the eye or penetrating injury. Bleeding from trauma fills the anterior chamber of the eye resulting in an acute increase in eye pressure. The mechanism of this pathology is due to red blood cells deposition from the bleeding and release of inflammatory mediators. This form of glaucoma can be urgent depending on the severity of pressure. The goal of treatment is to maintain the eye structure and control the bleeding of the eye. Pharmacotherapy includes, but is not limited to: topical steroids, limit physical exercise, and cycloplegics to name a few. If eye pressure remains uncontrolled and is too highly elevated, surgical therapy may be required, in the form of a trabeculoplasty.
Steroid-Induced Glaucoma
Increased eye pressure affecting the optic nerve and visual fields caused by the use of steroid medications. Some steroids have a more potent effect on eye pressure than other. Steroid drops have a more dramatic effect on eye pressure than inhaled steroids. People that share first degree relatives that have experienced the same effects are more susceptible to developing glaucoma caused by steroid use. People with open-angle glaucoma, type 1 diabetes, and nearsightedness are more likely to be affected by steroids. Treatment for steroid-induced glaucoma includes, eye pressure reducing agents.
Inflammation-Associated Glaucoma
Inflammation of the ciliary body of the eye leads to less aqueous fluid production and increased uveoscleral outflow. Over time the increased aqueous outflow resistance leads to uveitis. The aqueous contains prostaglandins that aid in the role of inflammation with people suffering from inflammation-associated glaucoma, thereby causing elevated eye pressure. Uveitis can be a secondary form of open-angle or closed-angle or both. It is a swelling of the uvea in the anterior portion of the eye. Uveitis is associated Fuchs’ Heterochromic iridocyclitis and Posner-Schlossman Syndrome. It can present blurred vision, eye pain, or brow pain. The diagnosis of uveitis is made by the presence of inflammatory cells and flare in the anterior chamber of the eye. It is treated with the administration of topical beta antagonists or alpha agonists. If the eye pressure is poorly controlled, then NSAIDs or corticosteroids may be prescribed. Mydriatic-cycloplegic medications are used to prevent ciliary muscle spasms of the eye.
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