By George A. Cioffi, MD
This part underwent significant revision for the 2008-2009 edition.
Topics mentioned comprise the epidemiologic features of glaucoma; hereditary and genetic components; intraocular strain and aqueous humor dynamics; scientific assessment; clinical administration of and surgical remedy for glaucoma. This variation includes up-to-date tables and revised photos, in addition to a number of new photographs illustrating either disorder entities and surgical options.
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Additional info for 2008-2009 Basic and Clinical Science Course: Section 10: Glaucoma (Basic and Clinical Science Course 2008-2009)
Patient's current complaint . symptoms, onset, duration, severity,location . ocular history . history of present illness . past ocular, medical, and surgical history . general medical history . past systemic medical history (including medications . review of systems . social history . history of alcohol and tobacco use and allergies) . occupation, avocation, interests . family history It is often useful to question the patient specifically about symptoms and conditions associated with glaucoma, such as pain, redness, colored halos around lights, alteration of vision, and loss of vision.
The most commonly used gonioscopic grading systems are the Shaffer and Spaeth systems. A quadrant-by-quadrant narrative description of the chamber angle noting localized findings such as neovascular tufts, angle recession, or PAS may also be used to document serial gonioscopic findings. If a grading system is used, the clinician should specify which system is being used. The Shaffer system describes the angle between the trabecular meshwork and the iris as follows: . Grade 4: The angle between the iris and the surface of the trabecular meshwork is 450.
Orbital varices are associated with secondary glaucoma. Intermittent unilateral proptosis and dilated eyelid veins are key external signs of orbital varices. Carotid cavernous, dural cavernous, and other arteriovenous fistulae can produce orbital bruits, restricted CHAPTER 3: Clinical Evaluation. 35 ocular motility, proptosis, and pulsating exophthalmos. Superior vena cava syndrome can cause proptosis and facial and eyelid edema, as well as conjunctival chemosis. Thyroidassociated orbitopathy and its associated glaucoma are associated with exophthalmos, eyelid retraction, and motility disorders.