Glaucoma classification

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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]

The glaucoma is typically classified is as open angle or closed angle and as primary or secondary. There have been multiple schemes proposed for the classification for glaucoma. However the classification of the glaucomas based on initial events and classification based on mechanisms of outflow obstruction are commonly used.

Classification on basis of angle

Open-angle Glaucoma

  1. Primary open-angle glaucoma (POAG)
    • not associated with known ocular or systemic disorders that cause increased resistance to aqueous outflow or damage to optic nerve
    • usually associated with elevated IOP
  2. Normal-tension glaucoma
    • considered in continuum of POAG; often used when IOP is not elevated
  3. Juvenile open-angle glaucoma
    • used when open-angle glaucoma diagnosed at young age (typically 10-30 years of age)
  4. Glaucoma suspect
    • normal optic disc and visual field associated with elevated IOP
    • suspicious optic disc and/or visual field with normal IOP
  5. Secondary open-angle glaucoma
    • increased resistance to trabecular meshwork outflow associated with other conditions (e.g. pigmentary-, phacolytic-, steroid-induced-)
    • increased posttrabecular resistance to outflow secondary to elevated episcleral venous pressure (e.g. carotid cavernous sinus fistula)

Angle-Closure Glaucoma

  1. Primary ACG with relative pupillary block
    • movement of aqueous humor from posterior chamber to anterior chamber restricted
    • peripheral iris in contact with trabecular meshwork
    • Acute angle closure
    • occurs when IOP rises rapidly as a result of relatively sudden blockage of the trabecular meshwork
    • Subacute angle closure (intermittent angle closure)
    • repeated, brief episodes of angle closure with mild symptoms and elevated IOP, often a prelude to acute angle closure
    • Chronic angle closure
    • IOP elevation caused by variable portions of anterior chamber angle being permanently closed by PAS
    • Secondary ACG with pupillary block
    • e.g. swollen lens, secluded pupil
    • Secondary ACG without pupillary block
    • posterior pushing mechanism: lens-iris diaphragm pushed forward (e.g. posterior segment tumor, scleral buckling procedure, uveal effusion)
    • anterior pulling mechanism: anterior segment process pulling iris forward to form PAS (e.g. iridocorneal endothelial syndrome, neovascular glaucoma, inflammation)
    • Plateau iris syndrome
    • primary angle closure with or without component of pupillary block, but pupillary block is not predominant mechanism of angle closure

Childhood Glaucoma

  1. Primary congenital/infantile glaucoma
  • primary glaucoma present from birth to first few years of life
  1. Glaucoma associated with congenital anomalies
  • associated with ocular disorders (e.g. anterior segment dysgenesis, aniridia)
  • associated with systemic disorders (e.g. rubella, Lowe syndrome)
  1. Secondary glaucoma in infants and children
  • e.g. glaucoma secondary to retinoblastoma or trauma

Classification on basis of etiology

Congenital and Developmental Glaucoma (Q15.0)

  • Developmental glaucoma

Primary Glaucoma and its Variants (H40.1-H40.2)

  • Primary glaucoma
  • Primary open-angle glaucoma, also known as chronic open-angle glaucoma, chronic simple glaucoma, glaucoma simplex
  • Low-tension glaucoma
  • Primary angle-closure glaucoma, also known as primary closed-angle glaucoma, narrow-angle glaucoma, iris- block glaucoma, acute congestive glaucoma
  • Variants of primary glaucoma

Secondary Glaucoma (H40.3-H40.6)

  • Secondary glaucoma
  • Phacogenic glaucoma
  • Angle-closure glaucoma with mature cataract
  • Phacoanaphylactic glaucoma secondary to rupture of lens capsule
  • Phacolytic glaucoma due to phacotoxic meshwork blockage
  • Subluxation of lens
  • Traumatic glaucoma
  • Angle recession glaucoma: Traumatic recession on anterior chamber angle
  • Postsurgical glaucoma
  • Glaucoma of miscellaneous origin

Absolute Glaucoma (H44.5)

  • Absolute glaucoma

References

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