Open-angle glaucoma
Background
- Elevated intraocular pressure and resulting optic nerve damage manifested initially as visual field loss and ultimately irreversible blindness if left untreated
- Unclear pathogenesis, however thought to be related to two mechanisms:
- Increased aqueous production
- Decreased outflow
Clinical Features
- Rarely experience symptoms, in contrast to acute angle closure glaucoma
- Typical pattern characterized by progressive peripheral visual field loss followed by central field loss, usually but not always associated with elevated intraocular pressure
Differential Diagnosis
Acute Vision Loss (Noninflamed)
- Painful
- Arteritic anterior ischemic optic neuropathy
- Optic neuritis
- Temporal arteritis†
- Painless
- Amaurosis fugax
- Central retinal artery occlusion (CRAO)†
- Central retinal vein occlusion (CRVO)†
- High altitude retinopathy
- Open-angle glaucoma
- Posterior reversible encephalopathy syndrome (PRES)
- Retinal detachment†
- Stroke†
- Vitreous hemorrhage
- Traumatic optic neuropathy (although may have pain from the trauma)
†Emergent Diagnosis
Evaluation
Workup
Diagnosis
- Characteristic nerve damage (eg, cupping) on fundus examination
- Visual field abnormalities
- +/- elevated IOP