Differential Diagnosis of Glaucoma: Key Conditions to Consider

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The differential diagnosis (DDx) of glaucoma involves distinguishing it from other conditions that can cause similar symptoms or findings. Glaucoma is characterized by optic nerve damage and visual field loss, often associated with elevated intraocular pressure (IOP). Here are some conditions to consider in the differential diagnosis of glaucoma:

1. Ocular Hypertension: Elevated IOP without optic nerve damage or visual field loss. It requires monitoring as it can progress to glaucoma.

2. Normal-Tension Glaucoma: Optic nerve damage and visual field loss occur despite normal IOP levels. It can be confused with other optic neuropathies.

3. Angle-Closure Glaucoma: Characterized by a sudden increase in IOP due to blocked drainage angles. It can be mistaken for other causes of acute red eye, such as conjunctivitis or uveitis.

4. Secondary Glaucoma: Caused by another eye condition or systemic disease, such as:

   • Neovascular Glaucoma: Associated with conditions like diabetic retinopathy or retinal vein occlusion.
   • Pigmentary Glaucoma: Caused by pigment dispersion syndrome.
   • Pseudoexfoliative Glaucoma: Associated with pseudoexfoliation syndrome.
   • Uveitic Glaucoma: Related to inflammation in the eye.

5. Optic Neuritis: Inflammation of the optic nerve, often associated with multiple sclerosis, can mimic glaucoma but typically presents with pain and rapid vision loss.

6. Ischemic Optic Neuropathy: Sudden vision loss due to reduced blood flow to the optic nerve, often in older adults.

7. Congenital Glaucoma: Present at birth or develops in early childhood, characterized by enlarged eyes and corneal clouding.

8. Other Optic Neuropathies: Such as those caused by nutritional deficiencies, toxins, or hereditary conditions.

9. Retinal Detachment: Can cause visual field loss but is usually associated with other symptoms like flashes and floaters.

10. Migraine with Aura: Can cause transient visual disturbances that might be confused with visual field defects.

Accurate diagnosis often requires a comprehensive eye examination, including measurement of IOP, assessment of the optic nerve head, visual field testing, and gonioscopy to evaluate the drainage angle. Imaging studies like optical coherence tomography (OCT) can also be helpful in assessing the optic nerve and retinal nerve fiber layer.