Last reviewed: November 2017
Last updated: December  2016

Summary

Definition

History and exam

Key diagnostic factors

  • cup-to-disk ratio >0.4
  • notching of optic nerve cup
  • peripheral vision loss
  • increased intraocular pressure
  • scotomas
  • loss of nerve fiber layer
  • retinal hemorrhage

Risk factors

  • intraocular pressure >23 mmHg
  • age >50 years
  • FHx of glaucoma
  • black ethnicity
  • myopia
  • diabetes mellitus
  • hypertension

Diagnostic investigations

1st investigations to order

  • tonometry
  • direct ophthalmoscopy
  • indirect ophthalmoscopy
  • slit-lamp biomicroscopy
  • visual field testing
Full details

Investigations to consider

  • gonioscopy
  • photographs of the optic nerve head
  • pachymetry
  • nerve fiber layer analysis
  • optical coherence tomography scanning
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Consultant Ophthalmic Surgeon

Glaucoma Specialist

University Hospital Southampton NHS Trust

Southampton

UK

Disclosures

NA has received honoraria for educational talks from Thea Pharmaceuticals and Allergan. These companies manufacture drops used in the treatment of open angle glaucoma.

Dr Nishani Amerasinghe would like to gratefully acknowledge Dr Robert B. Avery and Dr Michael N. Wiggins, the previous contributors to this monograph. RBA and MNW declare that they have no competing interests.

Peer reviewers VIEW ALL

Associate Professor of Ophthalmology

Department of Ophthalmology

Jones Eye Institute

University of Arkansas for Medical Sciences

Little Rock

AR

Disclosures

RAH declares that he has no competing interests.

Consultant Ophthalmologist

Queen Margaret Hospital

Dunfermline

Fife

UK

Disclosures

RS declares that she has no competing interests.

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