Glaucoma classification
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Rohan Bir Singh, M.B.B.S.[2]
Overview
The glaucoma is typically classified is as open angle or closed angle and as primary or secondary. There have been multiple schemes proposed for the classification for glaucoma. However the classification of the glaucomas based on initial events and classification based on mechanisms of outflow obstruction are commonly used.
Classification Based Upon Angle
| Open-angle Glaucoma | |
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| Primary open-angle glaucoma (POAG) (H40.11) |
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| Normal-tension glaucoma (H40.12) |
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| Juvenile open-angle glaucoma |
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| Glaucoma suspect (H40.0) |
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| Secondary open-angle glaucoma
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| Angle-Closure Glaucoma | |
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| Primary ACG with relative
pupillary block |
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| Acute angle closure
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| Subacute angle closure (intermittent angle closure)
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| Chronic angle closure |
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| Secondary ACG with pupillary block |
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| Secondary ACG without pupillary block
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| Plateau iris syndrome |
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| Childhood Glaucoma | |
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| Primary congenital/infantile glaucoma
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| Glaucoma associated with congenital anomalies
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| Secondary glaucoma in infants and children
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Classification based upon initial event
Congenital and Developmental Glaucoma (Q15.0)
- Developmental glaucoma
- Primary congenital glaucoma
- Infantile glaucoma
- Glaucoma associated with hereditary of familial diseases
Primary Glaucoma and its Variants (H40.1-H40.2)
- Primary glaucoma
- Variants of primary glaucoma
- Pigmentary glaucoma
- Exfoliation glaucoma, also known as pseudoexfoliative glaucoma or glaucoma capsulare
Secondary Glaucoma (H40.3-H40.6)
- Secondary glaucoma
- Inflammatory glaucoma
- Uveitis of all types
- Fuchs heterochromic iridocyclitis
- Phacogenic glaucoma
- Angle-closure glaucoma with mature cataract
- Phacoanaphylactic glaucoma secondary to rupture of lens capsule
- Phacolytic glaucoma due to phacotoxic meshwork blockage
- Subluxation of lens
- Glaucoma secondary to intraocular hemorrhage
- Traumatic glaucoma
- Angle recession glaucoma: Traumatic recession on anterior chamber angle
- Postsurgical glaucoma
- Neovascular glaucoma
- Drug-induced glaucoma
- Corticosteroid induced glaucoma
- Alpha- chymotrypsin glaucoma. Postoperative ocular hypertension from use of alpha chymotrypsin.
- Glaucoma of miscellaneous origin
- Associated with intraocular tumors
- Associated with retinal detachments
- Secondary to severe chemical burns of the eye
- Associated with essential iris atrophy
Absolute Glaucoma (H44.5)
- Absolute glaucoma
Classification based upon mechanism of outflow obstruction
Open Angle Glaucoma Mechanisms
- Pre-trabecular (membrane overgrowth)
- fibrovascular membrane (neovascular glaucoma)
- endothelial layer, often with Descemet-like membrane (iridocorneal endothelial syndrome, posterior polymorphous dystrophy, penetrating and non-penetrating trauma)
- epithelial downgrowth
- fibrous ingrowth
- inflammatory membrane (Fuchs heterochromic iridocyclitis,luetic interstitial keratitis)
- Trabecular
- idiopathic (chronic open-angle glaucoma, juvenile open-angle glaucoma)
- “clogging” of trabecular meshwork
- red blood cells (hemorrhagic-, ghost cell-, sickled red blood cells)
- macrophages (hemolytic-, phacolytic-, melanomalytic-)
- neoplastic cells (primary ocular tumors, neoplastic tumors, juvenile xanthogranuloma)
- pigment particles (pigmentary-, exfoliation syndrome / glaucoma capsulare, malignant melanoma)
- protein (uveitis, lens-induced glaucoma)
- viscoelastic agents
- α-chymotrypsin-induced glaucoma
- vitreous
- alterations of the trabecular meshwork
- steroid-induced glaucoma
- edema (uveitis, scleritis, episcleritis, alkali burns)
- trauma (angle recession)
- intraocular foreign bodies (hemosiderin, chalcosis)
- Post-trabecular
- obstruction of Schlemm’s canal (e.g. collapse at canal)
- elevated episcleral venous pressure
- carotid cavernous fistula
- cavernous sinus thrombosis
- retrobulbar tumors
- thyroid ophthalmopathy
- superior vena cava obstruction
- mediastinal tumors
- Sturge-Weber syndrome
- familial episcleral venous pressure elevation
Angle Closure Glaucoma Mechanisms
- Anterior (“pulling”)
- contracture of membranes
- neovascular glaucoma
- iridocorneal endothelial syndrome
- posterior polymorphous dystrophy
- penetrating and non-penetrating trauma
- consolidation of inflammatory products
- Posterior (“pushing”)
- with pupillary block
- pupillary block glaucoma
- lens-induced mechanisms (phacomorphic lens, ectopia lentis)
- posterior synechiae (iris-vitreous block, pseudophakia, uveitis)
- without pupillary block
- ciliary block (malignant) glaucoma
- lens-induced mechanisms (phacomorphic lens, ectopia lentis)
- following lens extraction (forward vitreous shift)
- anterior rotation of ciliary body (following scleral buckling or panretinal photocoagulation, central retinal vein occlusion)
- intraocular tumors (retinoblastoma, malignant melanoma)
- cysts of the iris and ciliary body
- retrolenticular tissue contracture (retinopathy of prematurity, persistent hyperplastic primary vitreous)
Developmental Anomalies of Angle
- incomplete development of trabecular meshwork / Schlemm’s canal
- congenital (infantile) glaucoma
- Axenfeld-Rieger syndrome
- Peter’s anomaly
- glaucomas associated with other developmental anomalies
- iridocorneal adhesions
- broad strands (Axenfeld-Rieger syndrome)
- fine strands that contract to close angle (aniridia)
Combined Mechanism Glaucoma
- Combination of two or more forms of glaucoma present either sequentially or simultaneously
- IOP elevation can occur as a result of either or both of the following:
- the intrinsic resistance of the trabecular meshwork to aqueous outflow in open-angle glaucoma
- the direct anatomic obstruction of the filtering meshwork by synechiae in ACG