Ophthalmological Pathological and Management in Eye Disease: Glaucoma (Diagnosis and Treatment)

Glaucoma, the leading cause of irreversible blindness, is classified into two types: open-angle, with aqueous humour (AH) passing freely through the trabecular meshwork (TM) and angle-closure, in which the access of the AH to the TM is blocked. Both types can be primary or secondary to ocular or systemic diseases. Primary open angle glaucoma (POAG) is a chronic, bilateral, progressive and irreversible optic neuropathy, at least partly related to intraocular pressure (IOP), in which the loss of neuroretinal rim and retinal nerve fibres’ layer (RNFL) translates into typical visual field (VF) defects. The cause of POAG is unknown and the clinical picture lacks in symptoms until the advanced disease stages. The goal of treatment is to stabilize disease progression, by reaching a target IOP at which the VF, optic disc and RNFL are stable, with the help of medical, laser and/or surgical means. Primary angle closure glaucoma has an acute onset with severe decrease of the visual acuity in a very painful red eye, without or with minor previous clinical manifestations. It is an emergency, the delay of medical care leading to vision loss. Once IOP is decreased with medical means, laser and/or surgical treatment is performed. Peripheral laser iridotomy in the fellow eye is mandatory. Whenever the cause of elevated IOP leading to optic nerve damage can be identified, the glaucoma is considered secondary and it is treated by addressing the cause. Childhood glaucoma (primary or secondary) is a relatively uncommon condition in which IOP control is very challenging.