Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- razão escavação/disco >0.5
- entalhe da escavação do nervo óptico
- perda da visão periférica sintomática
- aumento da pressão intraocular
- escotomas
- perda da camada de fibra nervosa
- hemorragia do disco óptico
Other diagnostic factors
- histerese da córnea
Risk factors
- pressão intraocular >21 mmHg
- idade >50 anos
- histórico familiar de glaucoma
- Anormalidades genéticas
- etnia negra ou etnia hispânica
- miopia
- diabetes mellitus
- hipertensão
- baixa pressão de perfusão ocular
- espessura fina da córnea central
- histerese da córnea
- bloqueadores dos canais de cálcio
Diagnostic investigations
1st investigations to order
- tonometria
- gonioscopia
- oftalmoscopia direta
- oftalmoscopia indireta
- biomicroscopia com lâmpada de fenda
- teste de campo visual
- varredura por tomografia de coerência óptica
Investigations to consider
- imagem digital
- paquimetria
- análise da camada de fibra nervosa
Emerging tests
- histerese da córnea
Treatment algorithm
colírios preferenciais ou trabeculoplastia a laser contraindicados/falharam
preferência por trabeculoplastia a laser ou colírios contraindicados/falharam
colírios contraindicados/falharam e a doença é rapidamente progressiva
falha do tratamento
Contributors
Authors
Nishani Amerasinghe, MBBS, BSc(Hons), FRCOphth
Consultant Ophthalmic Surgeon
Glaucoma Specialist
University Hospital Southampton NHS Trust
Southampton
UK
Disclosures
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
Disclosures
ISV has received consultancy/travel fees from Glaukos.
Acknowledgements
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.
Disclosures
RBA and MNW declare that they have no competing interests.
Peer reviewers
Andrew Chen, MD
Assistant Professor
University of Washington
Seattle
WA
Disclosures
AC declares that he has received research funding from Janssen LLC.
Sheila Sanders, MD
Professor of Ophthalmology
University of Kentucky
South Limestone
Lexington
KY
Disclosures
SS declares that she has no competing interests.
Mohamed Khodeiry, MD
Glaucoma Fellow
University of Kentucky
South Limestone
Lexington
KY
Disclosures
MK 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.
References
Key articles
Weinreb RN, Leung CK, Crowston JG, et al. Primary open-angle glaucoma. Nat Rev Dis Primers. 2016 Sep 22;2:16067. Abstract
International Council of Ophthalmology. ICO guidelines for glaucoma eye care. Feb 2016 [internet publication].Full text
American Academy of Ophthalmology. Primary open-angle glaucoma preferred practice pattern. Nov 2020 [internet publication].Full text
American Academy of Ophthalmology. Primary open-angle glaucoma suspect preferred practice pattern. Nov 2020 [internet publication].Full text
National Institute for Health and Care Excellence. Glaucoma: diagnosis and management. Jan 2022 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Glaucoma de tensão normal
- Glaucoma de ângulo fechado
- Alta miopia
More DifferentialsGuidelines
- Glaucoma summary benchmarks - 2024
- Trabeculectomy with a biodegradable collagen matrix implant for glaucoma
More GuidelinesPatient information
Glaucoma (ângulo aberto)
More Patient information
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer