LESSON 1: Eye, Ear, Nose, and Throat (EENT) Surgery

Section I: EYE SURGERY

1-16

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1-16. PROCEDURES IN THE TREATMENT OF GLAUCOMA

a. General. In glaucoma, there is increased tension or pressure within the eye. Increased intraocular pressure may lead to hardening of the eyeball and blindness. Glaucoma may result from iritis or from trauma.

b. Operative Procedures. The various operations used are aimed at reducing tension in the eye by improving intraocular drainage of fluid. The operation performed depends upon several factors, one being the status of the glaucoma (acute, subacute, or chronic).

(1) Iridotomy. This is incision of the iris. The operation is done to create a communication between the anterior and posterior chambers and thus relieve the acute phase of the attack of glaucoma.

 

(2) Iridectomy. This is excision of part of the iris. A sector of the iris is removed to increase drainage and relieve tension on the eye.

 

(3) Iridencleisis. This is the formation of an artificial pupil. A fistula is created to provide an outlet for aqueous humor. The iris is incised through an incision at the corneoscleral junction. The free ends are brought out and covered with conjunctival flap.

 

(4) Trephine. An opening is made by inserting a trephine through the cornea at the corneoscleral junction and cutting through the globe down to the posterior layer of corneoscleral tissue. The trephine is then removed and an iridectomy is performed. The surgeon may perform a trephine operation as the first surgical procedure in the treatment of glaucoma.

 

(5) Cyclodialysis. A new drainage channel is constructed from the anterior chamber so that aqueous humor drains into the suprachoroidal space. This operation is often done as treatment for glaucoma following cataract extraction.

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