Glaucoma pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Rohan Bir Singh, M.B.B.S.[2]

Overview

The underlying pathogenesis of glaucoma is attributed to retinal ganglion cell death due to elevated level of intraocular pressure. The intraocular pressure is determined by the balance between secretion of aqueous humor by the ciliary body and its drainage through the two pathways i.e. the trabecular meshwork and uveoscleral outflow pathway.

Pathophysiology

Anatomy

Brief overview of the anatomy of the eye may be helpful in understanding the causes of this disease:

Pathogenesis

  • The underlying pathogenesis of glaucoma is attributed to retinal ganglion cell death due to elevated level of intraocular pressure.
  • The intraocular pressure is determined by the balance between secretion of aqueous humor by the ciliary body and its drainage through the two pathways i.e. the trabecular meshwork and uveoscleral outflow pathway.
Anatomy of the Eye, according to Galen as the Arabs transferred to the West

Primary Open Angle Glaucoma

Angle Closure Glaucoma

  • The angle-closure glaucoma occurs as a result of an obstruction in access to the drainage pathways.
  • Typically, apposition or adhesion of the peripheral iris to the trabecular meshwork causes such an obstruction.
  • The portion of the anterior chamber angle affected by such apposition is “closed,” and drainage of aqueous humor through the angle is prohibited.[2]
  • The angle closure due to peripheral iris can either be appositional (transient obstruction) or synechial (permanent obstruction).
  • The consequence of either form of angle closure leads reduced aqueous outflow through the trabecular meshwork. The mechanisms of angle closure can be categorized into:
    • Mechanisms that push the iris forward from behind.
    • Mechanisms that pull

the iris forward into contact with the trabecular meshwork.

References

  1. Weinreb RN, Aung T, Medeiros FA (2014). "The pathophysiology and treatment of glaucoma: a review". JAMA. 311 (18): 1901–11. doi:10.1001/jama.2014.3192. PMC 4523637. PMID 24825645.
  2. Agarwal R, Gupta SK, Agarwal P, Saxena R, Agrawal SS (2009). "Current concepts in the pathophysiology of glaucoma". Indian J Ophthalmol. 57 (4): 257–66. doi:10.4103/0301-4738.53049. PMC 2712693. PMID 19574692.

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