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Home Ophthalmology

Glaucoma triad under controversy

Dr.Reda Gomah El Garia by Dr.Reda Gomah El Garia
August 29, 2018
in Ophthalmology
478 20
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Glaucoma triad under controversy

Glaucoma triad under controversy

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1 Raised IOP
1.1 ✍ >21 mmhg
2 Abnormal disc
3 VF defect
4 🛑 ‘ISNt rule’ describes

✍ high IOP ( the only modifiable risk factor and diagnosis of glaucoma can be made without ) never forget this point

✍ Abnormal disc

✍ consistent VF defect consistent with RNFL defect

 Raised IOP

✍ >21 mmhg

 Abnormal disc

✍ C/D ratio asymmetry > 0.2

✍ Large vertical C/D ratio for disc size > 0.5

✍ NRR notch or thinning (ISNT rule)

✍ Disc haemorrhage

✍ Vessel bayoneting and nasally displaced

✍ PPA (B-zone)

 VF defect

✍ Nasal step

✍ Paracentral scotoma

✍ Arcuate scotoma

✍ Altitudinal scotoma

✍ residual temporal

✍ central island of vision

🛑 ‘ISNt rule’ describes

☝ the normal contour of the disc rim

☝ thickest inferiorly, thinner superiorly, then nasally, and thinnest temporally.

☝ this rule often fails to apply when the optic discs have an anomalous configuration.

✍ Never forget 🚨 🚨 IOP does not need to be >21 mmhg to develop glaucomatous optic neuropathy.

✍ Anomalous optic discs are difficult to assess.

✍ raised IOP + normal disc + normal VF consider OHT

✍ raised IOP + suspicious disc + normal VF consider glaucoma suspect or preperimetric glaucoma

✍ raised IOP + suspicious disc + consistent VF defect consider highly suspicious and treated as glaucoma

✍ raised IOP + abnormal disc + consistent VF defect consider well established glaucoma

✍ Normal IOP+ normal disc + normal VF consider Normal

✍ normal IOP + suspicious disc + normal VF consider physiological cupping

✍ normal IOP + stable abnormal disc + stable VF defect consider congenital disc anomaly or previous disc insult

✍ normal IOP + evolving abnormal disc + evolving VF defect consider NTG

Glaucoma triad under controversy
Glaucoma triad under controversy
Tags: Glaucoma
Dr.Reda Gomah El Garia

Dr.Reda Gomah El Garia

Consultant Ophthalmologist at MALAZ MEDICAL GROUP

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