Secondary Glaucoma

SECONDARY GLAUCOMA


SECONDARY GLAUCOMA

  • Glaucoma that occurs as a complication of various other ocular conditions.

Important secondary glaucoma are described below:

LENS INDUCED GLAUCOMA

  • Patients are usually elder.

Following types of lens induced glaucoma are:

1. Phacomorphic glaucoma:

  • Occurs in intumescent stage of cataract.
  • The swollen lens leads to relative pupillary block (pupillary block glaucoma).
  • It is a type of angle closure glaucoma & anterior chamber is very shallow.
  • Also seen in anterior subluxation/dislocation of lens & spherophakia (congenital small spherical lens).

2. Phacolytic glaucoma:

  • In hypermature stage lens proteins leak out into the anterior chamber & are engulfed by macrophages.
  • These swollen macrophages clog the trabecular meshwork.
  • It is a type of open angle glaucoma.

3. Phacotopic glaucoma:

  • In hypermature stage, subluxation or dislocation of lens cause angle closure glaucoma.

4. Phacoanaphylactic uveitis & phacotoxic glaucoma:

  • It is chronic uveitis.
  • Occurs 1-14 days following cataract extraction or lens trauma.
  • Lens matter induces hypersensitivity uveitis .
  • The open angle glaucoma may be precipitated by clogging of trabecular meshwork by inflammatory cells & lens matter.

5. Lens particle glaucoma:

  • Type of open angle glaucoma.
  • Occurs due to blockade of trabecular meshwork by lens particle.

NEOVASCULAR GLAUCOMA (Rubeosis iridis)

  • It is a secondary angle closure glaucoma
  • Results due to formation of neovascular membrane over the iris i.e. neovascularisation of iris (rubeosis iridis).

Causes of rubeosis iridis are:

i) Common: 

  • Diabetic retinopathy (m/c cause)
  • Central retinal vein occlusion
  • Eale’s disease
  • Sickle-cell retinopathy

ii) Rare causes:

  • Central retinal artery occlusion
  • Intraocular inflammation (uveitis)
  • Retinoblastoma
  • Fusch’s heterochromatic iridocyclitis
  • In CRVO, glaucoma manifests about 100 days after thrombosis of central vein c/d 100 days glaucoma.
  • Treatment of choice is panretinal photocoagulation.

PIGMENTORY GLAUCOMA

  • Type of secondary open angle.
  • Occurs in young myopic males.

Characterstic feature is the deposition of pigment granules in antetrior segment such as:

  1. posterior surface of cornea (Krukenberg’s spindle)
  2. Trabecular meshwork
  3. ciliary zonules
  4. Crystalline lens
  • Iris transillumination shows radial slit-like transillumination defects in the mid periphery (pathognomonic features)
  • Treatment is as for primary open angle glaucoma.

GLAUCOMA SECONDARY TO INTRAOCULAR HAMORRHAGE

Intraocular hemorrhage (vitreous Hg/ hyperemia) may cause:

i) Red cell glaucoma:

  • Caused by blockade of trabeculae by RBCs .

ii) Haemolytic glaucoma:

  • Caused by an obstruction of trabecular meshwork by macrophagesladen with pigment, RBCs & debris.

iii) Ghost cell glaucoma:

  • Caused by blockage of pores of trabeculae by deformed RBCs.

iv) Hemosiderotic glaucoma:

  • Caused by sclerosis of trabecular meshwork caused by the iron (Siderosis).

IRIDOCORNEAL ENDOTHELIAL SYNDROME

Spectrum of conditions of eye where the corneal endothelium is abnormal which causes:

  1. Iris atrophy
  2. Secondary glaucoma
  3. Corneal edema
  • The main histological finding is the alteration in corneal endothelium that leads to deposition of collagen on posterior surface of Descemet’s membrane.

Three clinical variants are:

  1. Progressive iris atrophy (Essential iris atrophy)
  2. Chandler’s Syndrome: Changes in iris are minimal & corneal edema predominates.
  3. Cogan Rees Syndrome: These are nodular or diffuse pigmented lesions of the iris, also c/d iris naevus syndrome.

Exam Important

  • Intractable secondary glaucoma is seen in Diffuse iris melanoma.
  • Secondary glaucoma following corneal perforation is due to Peripheral anterior synechiae.
  • Secondary glaucoma associated with angle recession is seen in Concussion injury.
  • Iridocorneal endothelial syndrome is associated with Progressive atrophy of iris stroma.
  • Most common cause of neovascular glaucoma is Diabetes.
  • Rubeosis Iridis is most commonly seen in Diabetes mellitus.
  • Intumescent cataract is associated with Phacomorphic glaucoma.
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