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Increased intraocular pressure damages the optic tissue. Glaucoma is of two types viz. (i) open angle glaucoma and (ii) closed angle glaucoma.

Primary open angle glaucoma is often symptomless.. There is a gradual painless loss of vision along with constriction of field of vision. Headache is occasional. Defective vision with a sluggishly reacting pupil is diagnostic. In advanced stages, there is gross defective vision, increased tension, small and slowly reacting pupil. 2% pilocarpine 2-3 drops instilled every 4-6 hrs is of immense use.

In closed angle glaucoma, there is sudden redness of the eye, circumcorneal congestion, haziness of cornea and the pupils are dilated, almost oval and do not react briskly. Patients complain of rainbow haloes around light, headache especially on entering dark, occasionally vomiting, prostration and fever. The attacks are severe at night and hence patients report first in the outpatient department.

Acute catarrhal conjunctivitis also presents with redness of the eye and history of haloes around light. When the eye is washed and the discharge washed away, haloes disappear; congestion occurs in the lids too. Careful evaluation is necessary before excluding any case of glaucoma as ACCO.

Diabetic retinopathy

Development of retinopathy in diabetics depends upon the age of the patient rather than the severity of diabetes.

Diabetic retinopathy is of two types viz. (i) simple (ii) proliferative. Haemorrhages and exudates are visualised in the fundus in the simple type. Prothrombin and vasodilators help. In the proliferative type of retinopathy, vitreous haemorrhage and retinal detachment also occur. Photocoagulation, laser therapy and cryosurgery are found to be helpful. It is always important to advise diabetics to have a review every year to know the progress.

Hypertensive retinopathy

In hypertension with involu.tionary (senile) arteriosclerosis occurring in older patients, the picture of arteriosclerotic retinopathy appears. There are localised constriction and dilatation of vessels with sheathing of the vessels and the deposition of hard exudates and sometimes of haemorrhages without any oedema. Although the vascular changes are bilateral, the retinopathy is confined to one eye and the ocular prognosis is relatively good. A diastolic blood pressure above 100 mm of Hg can cause changes not unlike diabetes mellitus; if hypertension is controlled the disease process is arrested.

Central retinal arterial occlusion, central retinal venous occlusion, vitreous haemorrhage and retinal detachment are causes of sudden loss of vision. Senile macular degeneration may require glasses.

Mooren's Ulcer

This is a bilateral peripheral corneal degeneration with a gutter like opacity, conjunctival congestion and severe pain. Cornea melts from the periphery. Antibiotic drops along with atropine instillation and padded bandage help. Some cases may need corneal transplantation.

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