Early recognition of glaucoma is essential in managing this disease and preventing the natural outcome, which is a painful
and blind eye. Recognition is preceded by having a suspicion for glaucoma, and various signs, including fixed and dilated
pupils, engorged episcleral vessels, and a hazy cornea, should heighten this suspicion. Diagnostic tests can help to verify
the diagnosis, and referral of a glaucoma patient should be considered as an option to the owner.
A suspicion of glaucoma is based on the classical signs previously discussed. Certain breeds are highly predisposed, and the
most common breeds are the Basset Hound, American Cocker Spaniel, and Chow Chow. Clients who have these breeds as pets should
be pre-warned about the risk of glaucoma, and that should be followed up by periodic screening of intraocular pressures.
The minimum database for evaluation of a red, cloudy eye should include Schirmer tear tests, fluorescein dye test, and tonometry.
The anterior segment examination is best aided with magnification and bright focal illumination in a dark room. Tonometry
involves the estimation of intraocular pressure with various instruments. The Schiotz tonometer is the classic instrument
that has been around since the mid-1800s; it works on a principal of indentation. Modern instruments include those of applanation,
"Tono-Pen," and rebound, "TonoVet," tonometers. The Schiotz tonometer's principal of indentation is based on the theory that
hard eyes will indent very little and soft eyes will indent a lot. The instrument has a footplate fashioned for the curvature
of the human cornea. Once the footplate is placed on the cornea, the plunger will indent the globe. Numbers across the top
of the dial are correlated to fractions of millimeters of indentation, and these can be correlated with a table to intraocular
pressure. The most common applanation tonometer is the Tono-Pen, and it estimates pressure by flattening of the cornea. The
most common rebound tonometer, the TonoVet, has a plunger that bounces off the surface of the cornea, and the speed of rebound
is associated with intraocular pressure and the theory that a harder surface will rebound quicker. All three instruments have
their weaknesses and limitations, and operator skill is essential. Cleaning of the instruments also can affect accuracy.
Glaucoma is often defined as an intraocular pressure that is incompatible with vision. This gives a wide range of pressures
as possibilities. In human medicine, is low-pressure glaucoma is recognized. Certain breeds, based on metabolic conditions
such as diabetes, may have smaller elevations in intraocular pressure with more exaggerated loss of the optic nerve fibers.
Death of the optic nerve fibers is through loss of axoplasmic flow or hypoxia. Our general definition of glaucoma is an intraocular
pressure above 25 mmHg. Once initial tonometry has been taken and pressures are recognized, as elevated, immediate medical
intervention is essential.
Medical intervention includes the use of osmotic diuretics and various topical and systemic preparations to help reduce the
inflow of aqueous humor and expand the outflow. Osmotic diuretics work by dehydration and shrinkage of the vitreous cavity,
which creates a larger space in the anterior chamber. By reduction of the fluid volume within the globe, intraocular pressures
are lowered. Common osmotic diuretics include mannitol and glycerin. Glycerin is generally dosed at 0.75 mL per pound, and
it is essential to follow any osmotic diuretic by withholding water for a minimum of four hours and then slow reintroduction
of water over the next four to eight hours. An easy method for the slow reintroduction of water is filling the water bowl
with ice cubes, and as the ice cubes melt, the patient can rehydrate slowly.
Often, glaucoma is aggravated by secondary conditions and is triggered by inflammation. Anti-inflammatories, both systemic
and topical, are often part of the medical management. Antiglaucoma agents include carbonic anhydrase inhibitors, prostaglandin
analogues, and parasympathomimetics, both direct and indirect. Various alphaagonists and beta-blockers are a part of the modern
armamentarium for management of glaucoma.