Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- cup-to-disc ratio >0.4
- notching of optic nerve cup
- peripheral vision loss
- increased intra-ocular pressure
- scotomas
- loss of nerve fibre layer
- retinal haemorrhage
Risk factors
- intra-ocular pressure >23 mmHg
- age >50 years
- family history 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
Investigations to consider
- gonioscopy
- photographs of the optic nerve head
- pachymetry
- nerve fibre layer analysis
- optical coherence tomography scanning
Treatment algorithm
elevated intra-ocular pressure and/or visual and retinal changes
Contributors
Authors
Nishani Amerasinghe, MBBS, BSc(Hons), FRCOphth
Consultant Ophthalmic Surgeon
Glaucoma Specialist
University Hospital Southampton NHS Trust
Southampton
UK
Disclosures
NA has received travel honoraria and speaker's fees from Thea Pharmaceuticals and Allergan. She is also a principal investigator on an Aerie Pharmaceuticals study.
Acknowledgements
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
Richard A. Harper, MD
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.
Roshini Sanders, FRCS, FRCOphth
Consultant Ophthalmologist
Queen Margaret Hospital
Dunfermline
Fife
UK
Disclosures
RS declares that she has no competing interests.
Differentials
- Normal/low-tension glaucoma
- Closed-angle glaucoma
- High myopia
More DifferentialsGuidelines
- Glaucoma: diagnosis and management
- Glaucoma (primary open angle)
More GuidelinesPatient leaflets
Glaucoma
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