Considered in the evaluation of Normotensive Glaucoma are:
Considered in the evaluation of Normotensive Glaucoma are:
1. Irregular heart rate
2. Poor heart valves or Mitral Valve Prolapse. This leads to poor perfusion to the optic nerve, so anything that causes low pressure to the optic nerve, such as
3. Anemia or inflammatory or spastic vessel diseases (Raynaud's)
4. High incidence of disk hemorrhage (bruising of the optic nerve)
5. Visual Field loss that tends to be central
6. Characteristic loss of the pole of the optic nerve, called a "pseudo pit"
7. Atypical cupping
8. Low blood pressure, severe
9. Migraines and the medications used to treat them
In the differential are problems causing damage to the optic nerve, such as
1. Optic nerve compression, such as a pituitary tumor. Often a CT or MRI will find this
2. Optic atrophy from toxins, such as lead or methanol
3. Optic atrophy from an event called ischemic optic atrophy
4. High-pressure glaucoma (POAG) where the pressure spikes during the day or night; this is usually picked up with serial tonometry.
5. A relationship between glaucoma, often with normal pressures and the use of C- PAP has been reported.
6. Pressure Variable Glaucoma. This is probably common. Patients with pressure swings of more than 5mmHG may be at increased susceptibility to glaucoma like damage.
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