NHMRC Glaucoma Guidelines - ANZGIG
NHMRC Glaucoma Guidelines - ANZGIG
NHMRC Glaucoma Guidelines - ANZGIG
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<strong>NHMRC</strong> GUIDELINES FOR THE SCREENING, PROGNOSIS, DIAGNOSIS, MANAGEMENT AND PREVENTION OF GLAUCOMA<br />
Chapter 7 – Diagnosis of glaucoma<br />
Symptoms described by the patient<br />
Open angle glaucoma is generally symptomless in its early stages. It is not until significant<br />
neuronal damage has occurred that characteristic visual loss is observed.<br />
Acute angle closure (AAC) is associated with significant and distressing symptoms. These may<br />
present as either an acute scenario, or as patient descriptions of past attacks.<br />
Chronic angle closure symptoms are often absent. The symptoms that should alert health care<br />
providers to the presence of AC are detailed in Table 7.1, extracted from the European <strong>Glaucoma</strong><br />
Society [EGS] (2003).<br />
Table 7.1: Symptoms of angle closure<br />
SYMPTOMS<br />
Acute<br />
angle<br />
closure<br />
Intermittent<br />
angle closure<br />
Chronic angle closure<br />
Blurred vision √ At time of attack presents<br />
as AAC<br />
Between attacks may be<br />
symptomless<br />
Variable – chronic angle closure mimics<br />
primary open angle glaucoma<br />
It is asymptomatic until visual field loss<br />
interferes with quality of life<br />
Coloured rings<br />
around lights<br />
√<br />
Transient if present<br />
Pain √ Not usually<br />
Frontal headache √ Discomfort rather than pain<br />
Palpitations and<br />
abdominal pain<br />
Nausea and<br />
vomiting<br />
√<br />
√<br />
X<br />
X<br />
Examination of eye structure<br />
<strong>Glaucoma</strong> describes a group of eye diseases in which there is progressive damage to the optic<br />
nerve. This is characterised by specific structural abnormalities of optic nerve head and associated<br />
patterns of VF loss (Burr, Azuara-Blanco & Avenell 2004). Changes that occur in glaucoma include<br />
excavation of the optic nerve head (often termed cupping), loss of neuroretinal rim, and frequently,<br />
optic disc haemorrhages. It is essential to use the best possible approach to eye examination to<br />
identify these changes.<br />
Optic disc<br />
Ophthalmoscopy: Direct ophthalmoscopy is best performed with the pupils dilated and the<br />
room darkened. This provides a magnified view of the optic disc. The main disadvantage is the<br />
absence of a stereoscopic view. Indirect ophthalmoscopy performed with a slit lamp yields a<br />
magnified stereoscopic view of the optic disc and retinal nerve fibre layer. It is the examination<br />
method of choice.<br />
National Health and Medical Research Council 69