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Open-angle glaucoma

Evidence last reviewed: 24 Feb 2026
Topic last updated: 12 Jun 2025

Summary

Definition

História e exame físico

Principais fatores diagnósticos

  • cup-to-disk ratio >0.5
  • notching of optic nerve cup
  • symptomatic peripheral vision loss
  • increased intraocular pressure
  • scotomas
  • loss of nerve fiber layer
  • optic disk hemorrhage
Detalhes completos

Outros fatores diagnósticos

  • corneal hysteresis
Detalhes completos

Fatores de risco

  • intraocular pressure >21 mmHg
  • age >50 years
  • family history of glaucoma
  • genetic abnormalities
  • black ethnicity or Hispanic ethnicity
  • myopia
  • diabetes mellitus
  • hypertension
  • low ocular perfusion pressure
  • thin central corneal thickness
  • corneal hysteresis
  • calcium-channel blockers
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • tonometry
  • gonioscopy
  • direct ophthalmoscopy
  • indirect ophthalmoscopy
  • slit-lamp biomicroscopy
  • visual field testing
  • optical coherence tomography scanning
Detalhes completos

Investigações a serem consideradas

  • digital imaging
  • pachymetry
  • nerve fiber layer analysis
Detalhes completos

Novos exames

  • corneal hysteresis

Algoritmo de tratamento

AGUDA

eye drops preferred or laser trabeculoplasty contraindicated/failed

laser trabeculoplasty preferred or eye drops contraindicated /failed

eye drops contraindicated /failed and rapidly progressive disease

CONTÍNUA

treatment failure

Colaboradores

Autores

Nishani Amerasinghe, MBBS, BSc(Hons), FRCOphth

Consultant Ophthalmic Surgeon

Glaucoma Specialist

University Hospital Southampton NHS Trust

Southampton

UK

Declarações

NA is president-elect of the UK and Éire Glaucoma Society and has acted as an unpaid advisor to NICE and The Royal College of Ophthalmologists. NA has served on an advisory panel for Santen and has received travel honoraria and speaker's fees from Thea Pharmaceuticals, Santen, and Allergan. NA has received research funding from AbbVie Pharmaceuticals.

Irena Serov-Volach, MD

Senior Glaucoma and Cataract Fellow

Ophthalmology department

Eye Unit

Epsom and St Helier University Hospitals NHS Trust

London

UK

Declarações

ISV has received consultancy/travel fees from Glaukos.

Agradecimentos

Dr Nishani Amerasinghe and Dr Irena Serov-Volach would like to gratefully acknowledge Dr Robert B. Avery and Dr Michael N. Wiggins, the previous contributors to this topic.

Declarações

RBA and MNW declare that they have no competing interests.

Revisores

Andrew Chen, MD

Assistant Professor

University of Washington

Seattle

WA

Declarações

AC declares that he has received research funding from Janssen LLC.

Sheila Sanders, MD

Professor of Ophthalmology

University of Kentucky

South Limestone

Lexington

KY

Declarações

SS declares that she has no competing interests.

Mohamed Khodeiry, MD

Glaucoma Fellow

University of Kentucky

South Limestone

Lexington

KY

Declarações

MK declares that he has no competing interests.

Roshini Sanders, FRCS, FRCOphth

Consultant Ophthalmologist

Queen Margaret Hospital

Dunfermline

Fife

UK

Declarações

RS declares that she has no competing interests.

Créditos aos pareceristas

Os tópicos do BMJ Best Practice são constantemente atualizados, seguindo os desenvolvimentos das evidências e das diretrizes. Os pareceristas aqui listados revisaram o conteúdo pelo menos uma vez durante a história do tópico.

Declarações

As afiliações e declarações dos pareceristas referem--se ao momento da revisão.

Referências

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Principais artigos

Weinreb RN, Leung CK, Crowston JG, et al. Primary open-angle glaucoma. Nat Rev Dis Primers. 2016 Sep 22;2:16067. Resumo

International Council of Ophthalmology. ICO guidelines for glaucoma eye care. Feb 2016 [internet publication].Texto completo

American Academy of Ophthalmology. Primary open-angle glaucoma preferred practice pattern. Nov 2020 [internet publication].Texto completo

American Academy of Ophthalmology. Primary open-angle glaucoma suspect preferred practice pattern. Nov 2020 [internet publication].Texto completo

National Institute for Health and Care Excellence. Glaucoma: diagnosis and management. Jan 2022 [internet publication].Texto completo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
  • Open-angle glaucoma images
  • Diagnósticos diferenciais

    • Normal-tension glaucoma
    • Angle-closure glaucoma
    • High myopia
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  • Diretrizes

    • Glaucoma summary benchmarks - 2024
    • Trabeculectomy with a biodegradable collagen matrix implant for glaucoma
    Mais Diretrizes
  • Folhetos informativos para os pacientes

    Glaucoma

    Mais Folhetos informativos para os pacientes
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