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Elevated Intraocular Pressure
Ocular hypertension is the presence of elevated fluid pressure inside the eye (intraocular pressure), usually with no optic nerve damage or visual field loss. For most individuals, the normal range of intraocular pressure is between 10 mmHg and 21 mmHg. It is estimated that approximately 2-3% of people aged 52-89 years old have ocular hypertension of 25 mmHg and higher, and 3.5% of people 49 years and older have ocular hypertension of 21 mmHg and higher. Elevated intraocular pressure is an important risk factor and symptom of glaucoma. Accordingly, most individuals with consistently elevated intraocular pressures of greater than 21mmHg, particularly if they have other risk factors, are treated in an effort to prevent vision loss from glaucoma. Pathophysiology One of the fluids inside the eye is called aqueous humor, and it contains 99% water and removes waste. Aqueous humor is transparent and thin, located in the anterior chamber, which is the area between the cornea and iris. ...
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Ophthalmology
Ophthalmology (, ) is the branch of medicine that deals with the diagnosis, treatment, and surgery of eye diseases and disorders. An ophthalmologist is a physician who undergoes subspecialty training in medical and surgical eye care. Following a medical degree, a doctor specialising in ophthalmology must pursue additional postgraduate residency training specific to that field. In the United States, following graduation from medical school, one must complete a four-year residency in ophthalmology to become an ophthalmologist. Following residency, additional specialty training (or fellowship) may be sought in a particular aspect of eye pathology. Ophthalmologists prescribe medications to treat ailments, such as eye diseases, implement laser therapy, and perform surgery when needed. Ophthalmologists provide both primary and specialty eye care—medical and surgical. Most ophthalmologists participate in academic research on eye diseases at some point in their training and many inc ...
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Pressure
Pressure (symbol: ''p'' or ''P'') is the force applied perpendicular to the surface of an object per unit area over which that force is distributed. Gauge pressure (also spelled ''gage'' pressure)The preferred spelling varies by country and even by industry. Further, both spellings are often used ''within'' a particular industry or country. Industries in British English-speaking countries typically use the "gauge" spelling. is the pressure relative to the ambient pressure. Various #Units, units are used to express pressure. Some of these derive from a unit of force divided by a unit of area; the International System of Units, SI unit of pressure, the Pascal (unit), pascal (Pa), for example, is one newton (unit), newton per square metre (N/m2); similarly, the Pound (force), pound-force per square inch (Pound per square inch, psi, symbol lbf/in2) is the traditional unit of pressure in the imperial units, imperial and United States customary units, US customary systems. Pressure ma ...
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Intraocular Pressure
Intraocular pressure (IOP) is the fluid pressure inside the eye. Tonometry is the method eye care professionals use to determine this. IOP is an important aspect in the evaluation of patients at risk of glaucoma. Most tonometers are calibrated to measure pressure in millimeters of mercury (mmHg). Physiology Intraocular pressure is determined by the production and drainage of aqueous humour by the ciliary body and its drainage via the trabecular meshwork and uveoscleral outflow. The reason for this is because the vitreous humour in the posterior segment has a relatively fixed volume and thus does not affect intraocular pressure regulation. An important quantitative relationship (Goldmann's equation) is as follows: :P_o = \frac + P_v Where: * P_o is the IOP in millimeters of mercury (mmHg) * F the rate of aqueous humour formation in microliters per minute (μL/min) * U the resorption of aqueous humour through the uveoscleral route (μL/min) * C is the facility of outflow in mic ...
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Optic Nerve
In neuroanatomy, the optic nerve, also known as the second cranial nerve, cranial nerve II, or simply CN II, is a paired cranial nerve that transmits visual system, visual information from the retina to the brain. In humans, the optic nerve is derived from optic stalks during the seventh week of development and is composed of retinal ganglion cell axons and glial cells; it extends from the optic disc to the optic chiasma and continues as the optic tract to the lateral geniculate nucleus, Pretectal area, pretectal nuclei, and superior colliculus. Structure The optic nerve has been classified as the second of twelve paired cranial nerves, but it is technically a myelinated tract of the central nervous system, rather than a classical nerve of the peripheral nervous system because it is derived from an out-pouching of the diencephalon (optic stalks) during embryonic development. As a consequence, the fibers of the optic nerve are covered with myelin produced by oligodendrocytes, r ...
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Visual Field Test
A visual field test is an eye examination that can detect dysfunction in central and peripheral vision which may be caused by various medical conditions such as glaucoma, stroke, pituitary disease, brain tumours or other neurological deficits. Visual field testing can be performed clinically by keeping the subject's gaze fixed while presenting objects at various places within their visual field. Simple manual equipment can be used such as in the tangent screen test or the Amsler grid. When dedicated machinery is used it is called a perimeter. The exam may be performed by a technician in one of several ways. The test may be performed by a technician directly, with the assistance of a machine, or completely by an automated machine. Machine-based tests aid diagnostics by allowing a detailed printout of the patient's visual field. Other names for this test may include perimetry, Tangent screen exam, Automated perimetry exam, Goldmann visual field exam, or brand names such as the H ...
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Glaucoma
Glaucoma is a group of eye diseases that can lead to damage of the optic nerve. The optic nerve transmits visual information from the eye to the brain. Glaucoma may cause vision loss if left untreated. It has been called the "silent thief of sight" because the loss of vision usually occurs slowly over a long period of time. A major risk factor for glaucoma is increased pressure within the eye, known as Intraocular pressure, intraocular pressure (IOP). It is associated with old age, a family history of glaucoma, and certain medical conditions or the use of some medications. The word ''glaucoma'' comes from the Ancient Greek word (), meaning 'gleaming, blue-green, gray'. Of the different types of glaucoma, the most common are called open-angle glaucoma and closed-angle glaucoma. Inside the eye, a liquid called Aqueous humour, aqueous humor helps to maintain shape and provides nutrients. The aqueous humor normally drains through the trabecular meshwork. In open-angle glaucoma, ...
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Ciliary Body
The ciliary body is a part of the eye that includes the ciliary muscle, which controls the shape of the lens, and the ciliary epithelium, which produces the aqueous humor. The aqueous humor is produced in the non-pigmented portion of the ciliary body. The ciliary body is part of the uvea, the layer of tissue that delivers oxygen and nutrients to the eye tissues. The ciliary body joins the ora serrata of the choroid to the root of the iris.Cassin, B. and Solomon, S. ''Dictionary of Eye Terminology''. Gainesville, Florida: Triad Publishing Company, 1990. Structure The ciliary body is a ring-shaped thickening of tissue inside the eye that divides the posterior chamber from the vitreous body. It contains the ciliary muscle, vessels, and fibrous connective tissue. Folds on the inner ciliary epithelium are called ciliary processes, and these secrete aqueous humor into the posterior chamber. The aqueous humor then flows through the iris into the anterior chamber. The ciliary bo ...
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Trabecular Meshwork
The trabecular meshwork is an area of tissue in the eye located around the base of the cornea, near the ciliary body, and is responsible for draining the aqueous humor from the eye via the anterior chamber (the chamber on the front of the eye covered by the cornea). The tissue is spongy and lined by trabeculocytes; it allows fluid to drain into a set of tubes called Schlemm's canal which is lined by endothelium with blood and lymphatic properties that allow aqueous humor to flow into the blood system. Structure The meshwork is divided up into three parts, with characteristically different ultrastructures: #''Inner uveal meshwork'' - Closest to the anterior chamber angle, contains thin cord-like trabeculae, orientated predominantly in a radial fashion, enclosing trabeculae spaces larger than the corneoscleral meshwork. #''Corneoscleral meshwork'' - Contains a large amount of elastin, arranged as a series of thin, flat, perforated sheets arranged in a laminar pattern; c ...
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Ocular Tonometry
Tonometry is the procedure that eye care professionals perform to determine the intraocular pressure (IOP), the fluid pressure inside the eye. It is an important test in the evaluation of patients at risk from glaucoma. Most tonometers are calibrated to measure pressure in millimeters of mercury (mmHg), with the normal eye pressure range between . Methods Applanation tonometry In applanation tonometry the intraocular pressure (IOP) is inferred from the force required to flatten (applanate) a constant area of the cornea, for the Imbert-Fick law. The Maklakoff tonometer was an early example of this method, while the Goldmann tonometer is the most widely used version in current practice. Because the probe makes contact with the cornea, a topical anesthetic, such as proxymetacaine, is introduced on to the surface of the eye in the form of an eye drop. Goldmann tonometry Goldmann applanation tonometry (GAT) is considered to be the gold standard IOP test and is the most widely ...
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Latanoprost
Latanoprost, sold under the brand name Xalatan among others, is a medication used to treat increased pressure inside the eye (intraocular pressure). This includes ocular hypertension and open-angle glaucoma. Latanaprost is applied as eye drops to the eyes. Onset of effects is usually within four hours, and they last for up to a day. Common side effects include blurry vision, redness of the eye, itchiness, and darkening of the iris. Latanoprost is in the prostaglandin analogue family of medications. It works by increasing the outflow of aqueous fluid from the eyes through the uveoscleral tract. Latanoprost was approved for medical use in the United States and the European Union in 1996. It is on the World Health Organization's List of Essential Medicines. Latanoprost is available as a generic medication. In 2022, it was the 67th most commonly prescribed medication in the United States, with more than 9million prescriptions. It is available as a fixed-dose combinat ...
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Travoprost
Travoprost, sold under the brand name Travatan among others, is a medication used to treat high pressure inside the eye including glaucoma. Specifically it is used for open angle glaucoma when other agents are not sufficient. It is used as an eye drop. Effects generally occur within two hours. Common side effects include red eyes, blurry vision, eye pain, dry eyes, and change in color of the eyes. Other significant side effects may include cataracts. Use during pregnancy or breastfeeding is generally not recommended. It is a prostaglandin analog and works by increasing the outflow of aqueous humor, aqueous fluid from the eyes. Travoprost was approved for medical use in the United States and in the European Union in 2001. It is available as a generic medication in the United Kingdom. In 2020, it was the 304th most commonly prescribed medication in the United States, with more than 1million prescriptions. Medical uses Travoprost is used to treat high pressure inside the eye ...
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Bimatoprost
Bimatoprost, sold under the brand name Lumigan among others, is a medication used to treat high pressure inside the eye including glaucoma. Specifically it is used for open angle glaucoma when other agents are not sufficient. It may also be used to increase the size of the eyelashes. It is used as an eye drop and effects generally occur within four hours. Common side effects include red eyes, dry eyes, change in color of the eyes, blurry vision, and cataracts. Use during pregnancy or breastfeeding is generally not recommended. It is a prostaglandin analog and works by increasing the outflow of aqueous fluid from the eyes. Bimatoprost was approved for medical use in the United States in 2001. It is available as a generic medication. In 2022, it was the 195th most commonly prescribed medication in the United States, with more than 2million prescriptions. Uses Medical Bimatoprost is used for the treatment of open-angle glaucoma and ocular hypertension in adults, either alo ...
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