Diagnostic considerations Measurement of intraocular pressure Elevated intraocular pressure in a routine ophthalmic examination is an alarming sign

Twenty-four-hour pressure curve. Fluctuations in intraocular pressure of over 5-6 mm Hg may occur over a 24-hour period.

Gonioscopy. The angle of the anterior chamber is open and appears as normal as the angle in patients without glaucoma.

Ophthalmoscopy. Examination of the optic nerve reveals whether glaucomatous cupping has already occurred and how far advanced the glaucoma is. Where the optic disk and visual field are normal, ophthalmoscopic examination of the posterior pole under green light may reveal fascicular nerve fiber defects as early abnormal findings.

Perimetry. Noise field perimetry is suitable as a screening test as it makes the patient aware of scotomas and makes it possible to detect and describe them. The patient is shown a flickering monitor displaying what resembles image noise on a television set. The patient will not see the flickering points in the region of the scotoma. After this test, the defect should be quantified by more specific methods. Automatic grid perimetry is suitable for the early stages of glaucoma. Special programs (such as the G1 program on the Octopus perimeter and the 30-2 program on the Humphrey perimeter devices) reveal the earliest glaucomatous changes. In advanced glaucoma, kinetic hand perimetry with the Goldmann perimeter device is a useful preliminary examination to evaluate the remaining field of vision.

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