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. 2011 Jan;59 Suppl(Suppl1):S43-52.
doi: 10.4103/0301-4738.73688.

Evaluation of a glaucoma patient

Ravi Thomas  1 , Klaus Loibl, R Parikh
Affiliations

Evaluation of a glaucoma patient

Ravi Thomas et al. Indian J Ophthalmol. 2011 Jan.

Abstract

The diagnosis of glaucoma is usually made clinically and requires a comprehensive eye examination, including slit lamp, applanation tonometry, gonioscopy and dilated stereoscopic evaluation of the optic disc and retina. Automated perimetry is obtained if glaucoma is suspected. This establishes the presence of functional damage and provides a baseline for follow-up. Imaging techniques are not essential for the diagnosis but may have a role to play in the follow-up. We recommend a comprehensive eye examination for every clinic patient with the objective of detecting all potentially sight-threatening diseases, including glaucoma.

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Conflict of interest statement

Conflict of Interest: None declared

Figures

Figure 1
Figure 1
“Brown” stage of pseuduexfoliation (Arrow indicates “brown” stage of PXF)
Figure 2
Figure 2
Indentation gonioscope
Figure 3
Figure 3
Normal angle anatomy (Broken arrow: Schwalbe’s line, White arrrow: Pigmented Trabecular Meshwork, Red arrow: Scleral Spur, Thick white arrow: Cilliary Body)
Figure 4
Figure 4
Gonioscopy showing angle with bright and dim illumination (Angle is open with bright illumination and the same angle is closed with appropriate testing conditons)
Figure 5
Figure 5
Gonioscopy showing “over the hill” angle (Gonioscopy showint no angle structure in straight ahead view. By tilting angle, “over the hill” view showing angle structures)
Figure 6
Figure 6
Gonioscopy showing peripheral anterior synechiae (Arrow showing peripheral anterior synechia)
Figure 7
Figure 7
Relation between optic disc size and cup [(a) Small disc and has a small cup. (b) Medium sized disc with a larger cup. (c) Large disc and a large cup]
Figure 8
Figure 8
Estimation of optic disc size (Narrrow the vertical height of the slit beam to match the disc height)
Figure 9
Figure 9
Neuro retinal rim: ISNT rule (Normally, inferior rim is thicker than superior rim, which in turn is thicker than nasal rim. Temporal rim is thinnest)
Figure 10
Figure 10
Optic disc showing early glaucoma (Loss of ISNT rule. Note that superior rim is thicker than inferior rim)
Figure 11
Figure 11
Optic disc with NOTCH
Figure 12
Figure 12
Optic disc showing disc hemorrhage (Rim to disc ratio <0.1:1 as seen here indicates glaucoma. Whith arrow indicates disc haemorrhage)
Figure 13
Figure 13
Red free optic disc photograph (Normal RNFL pattern: Bright dark bright pattern)
Figure 14
Figure 14
Optic photograph showing wedge-shaped defect (Arrow indiectes wedge shaped RNFL defects)
Figure 15
Figure 15
Red free photograph showing diffuse nerve fiber layer defects (Note that bright dark bright pattern is lost and it appears completely dark)
Figure 16
Figure 16
Normal visual field
Figure 17
Figure 17
Visual field with an early glaucomatous defect
Figure 18
Figure 18
Visual field in patients with media opacity
Figure 19
Figure 19
Glaucomatous visual field defect in the FDP 20 screening program (POAG patient with superior arcuate scotoma on WWP)
Figure 20
Figure 20
Evaluation of a glaucoma suspect (open angle glaucoma)
Figure 21
Figure 21
Evaluation of a glaucoma suspect (angle closure disease)
See this image and copyright information in PMC

References

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    1. Healey P, Thomas R, editors. Oxford UK: Health Press ltd; 2009. The fast facts in glaucoma; pp. 1–128.