Glaucoma

Features (Fig. 4.17)

ACUTE GLAUCOMA IS PAINFUL AND DEALT WITH ON PAGE 41.

■ chronic glaucoma is painless and is usually found on routine testing

■ field loss is usually only noticed when central vision is affected

■ family history common

allergic reaction to drops may occur (see p. 46, 50).

Normal disc "filled" with retinal nerve fibers ■ little room for central cup

Glaucomatous disc with only a few nerve fibers spread around the edge of the large central cup a

Note: Be aware that myopic (short sighted) people may have bigger discs and these may appear to be cupped. Conversely long sighted people (hypermetropes) have smaller eyes and discs and the nerve fibers may bunch up as they exit through the small disc. This may look like disc swelling or papilledema.

Fig. 4.17a, Pale cupped optic disc in advanced chronic glaucoma - compare this with a normal disc (Fig. 4.17c). b, Normal versus glaucomatous disc.

Fig. 4.17d Swollen optic disc - in this case papillitis - papilledema looks similar and is usually bilateral.

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