3.2 Glaucoma Differential Diagnosis and Aetiologies

Contents

Childhood Glaucoma

A. Primary
  1. Congenital (90% sporadic)
  2. Infantile
  3. Juvenile
B. Secondary

Anterior Segment Dysgenesis

Aniridia, Peters, Axenfeld-Rieger

Uveitic

Rubella, JIA

Lens

Aphakia

Retinal Vascular

PHPV

Systemic

Phakomatoses: Neurofibromatoses, Sturge Weber, Down, Marfans, Lowe syndrome

Trauma

Steroids

Figure 3.2.1 Childhood Glaucoma: Buphthalmos

Figure 3.2.1
Childhood Glaucoma: Buphthalmos

Figure 3.2.2 Childhood Glaucoma: Haab Striae

Figure 3.2.2
Childhood Glaucoma: Haab Striae

Figure 3.2.3 Childhood Glaucoma: Iridocorneal Adhesions in Peter’s Anomaly

Figure 3.2.3
Childhood Glaucoma: Iridocorneal Adhesions in Peter’s Anomaly

Figure 3.2.4 Childhood Glaucoma: Aniridia

Figure 3.2.4
Childhood Glaucoma: Aniridia

Glaucoma Drainage Implant Indications

↑ Outflow

  1. Wound leak
  2. Overfiltering bleb
  3. Ruptured globe
  4. Cyclodialysis cleft

↓ Production

  1. Uveitis
  2. Choroidal / retinal detachment
  3. Anti-glaucomatous drops
  4. Ocular ischaemia
  5. Phthisis bulbi
  6. (Dehydrated, uraemia, DM, myotonic dystrophy)

Hypotony

Patient Related

  1. Conjunctival scarring or inadequate conjunctiva
  2. Previous failed trabeculectomy
  3. Paediatric

Eye Related

  1. NVG
  2. Aphakic glaucoma
  3. ICE syndrome
  4. Inflammatory glaucoma

Neovascular Glaucoma (Rubeosis)

“IRATE”

I nflammatory

  1. Chronic Uveiti
  2. VKH
  3. Sympathetic ophthalmia

R etinal Ischaemia

  1. Proliferative DR
  2. CRVO
  3. Ocular ischaemic syndrome
  4. Radiation
  5. Chronic retinal detachment

A nterior Segment Ischaemia

  1. Scleral buckle
  2. Strabismus surgery

T umours

  1. Melanoma
  2. Retinoblastoma

E ndophthalmitis

Figure 3.2.5 Rubeosis Iridis

Figure 3.2.5
Rubeosis Iridis

Normal Tension Glaucoma Differentials

Undetected High Tension Glaucoma

  1. POAG (with diurnal variation)
  2. Prior IOP elevation
  3. Tonometric error, Thin CCT Cyclodialysis cleft

Non-glaucomatous Optic Nerve Disease

  1. Congenital- Optic disc pit?, Myopic
  2. Compression
  3. AAION
  4. Toxic - Methanol

Pigmentary Glaucomas

  1. PDS
  2. PXF
  3. Inflammatory (including Herpetic), Fuchs, Possner-Schlossman
  4. Angle closure
Figure 3.2.6
Krukenberg Spindle in Pigment Dispersion Syndrome

Figure 3.2.6
Krukenberg Spindle in Pigment Dispersion Syndrome

Figure 3.2.7 Hoarfrost Ring in Pseudoexfoliation Syndrome

Figure 3.2.7
Hoarfrost Ring in Pseudoexfoliation Syndrome

Post-Trabeculectomy Complications (Early)

Figure 3.2.8 Early Postoperative Trabeculectomy Complications

Figure 3.2.8
Early Postoperative Trabeculectomy Complications

Trabeculectomy Failure Risk Factors

“ARTIST”

A ge

Younger

R ace

Africans and Hispanics

T ype

Secondary and inflammatory

I nflammation

Uveitis, blepharitis, rosacea

S urgical History

Previous attempts

T rauma

Perforating / penetrating trauma

Unilateral Glaucoma Causes

Inflammatory

  1. Fuchs heterochromic iridocyclitis
  2. PXF
  3. ICE Syndrome
  4. Uveitic glaucoma
  5. Steroid induced

Infective

  1. Herpetic
  2. Posner-Schlossman

Traumatic

  1. Angle recession
  2. Cyclodialysis cleft

Other

  1. Acute angle closure
  2. Neovascular glaucoma
  3. PHPV
  4. Asymmetric POAG

          

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