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Ophthalmology > 1: Glaucoma > Flashcards

1: Glaucoma Flashcards

1
Q

Define glaucoma

A

Group of eye diseases that result in damage to optic nerve with or without raised IOP

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2
Q

What are the two types of glaucoma

A

Open-angle

Close-angle

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3
Q

What is open glaucoma

A

Iris does not obstruct the trabecular meshwork - enabling drainage of aqueous humour. This presents as a gradual loss of peripheral vision until late stages

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4
Q

What is close angle glaucoma

A

Iris obstructs the trabecular meshwork - preventing drainage of aqueous humour

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5
Q

What type of glaucoma is an emergency

A

Close-angle glaucoma

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6
Q

What are the 3 chambers of the eye

A

Anterior Aqueous Chamber
Posterior Aqueous Chamber
Posterior vitreous chamber

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7
Q

What is the anterior aqueous chamber

A

From lens to cornea

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8
Q

What is the posterior aqueous chamber

A

From lens to iris

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9
Q

What is the vitreous chamber

A

lens to retina

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10
Q

Explain circulation of aqueous humour and pathology in glaucoma

A
  • Aqueous humour is produced by ciliary epithelium and released into posterior chamber.
  • It passes from posterior chamber to anterior chamber
  • It is drained from anterior chamber by canal of schlemm to episcleral venous
  • If this is occluded, pressure may increase to cause intraocular HTN
  • High pressure can damage optic.N
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11
Q

What defines intraocular HTN in mmHg

A

> 21

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12
Q

What defines intra-ocular HTN in kPa

A

> 2.8kPa

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13
Q

What patients is open-angle glaucoma more common in

A

> 40
Female
Eastern-Asian

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14
Q

What are the two types of open-angle glaucoma

A

Primary

Secondary

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15
Q

What is primary angle close glaucoma

A

Idiopathic

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16
Q

What is a risk factor for primary angle-closure glaucoma and why

A

Hypermetropia (Long-sightedness) as this means a shorter eyeball increasing risk of the iris occluding the trabecular meshwork

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17
Q

What is secondary angle-closure glaucoma

A

Due to trauma

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18
Q

Why does traumatic haemorrhage cause angle-closure glaucoma

A

Traumatic haemorrhage pushes the posterior chamber forward increasing risk if will occlude the trabecular meshwork

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19
Q

What are 3 risk factors for angle-closure glaucoma

A
  1. Hypermetropia
  2. Cataracts
  3. Cyclopentolate
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20
Q

What medication may precipitate angle-closure glaucoma

A

Cyclopentolate used for uveitis

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21
Q

How does acute angle-closure glaucoma present clinically

A

Acute-onset:

  • Blurring vision, Halos at night
  • Severe eye pain followed by headache
  • Red-eye
  • Eye watering
  • N+V
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22
Q

How will the pupil present in angle-closure glaucoma

A

Fixed mid-dilated pupil

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23
Q

What should be avoided in acute angle-closure glaucoma and why

A

Dark rooms and eye-patches as they cause pupil dilation further narrowing the network

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24
Q

What should happen with acute angle-closure glaucoma

A

Immediate referral to opthalmology

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25
Q

What is used to look at the eye in acute angle-closure glaucoma

A

Goinoscopy

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26
Q

What does a goinoscopy look at

A

Goinoscopy - able to look at the iridocorneal angle

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27
Q

Why do patients need an urgent referral to ophthalmology

A

For intra-ocular pressure monitoring and medication

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28
Q

What 3 medications should be started in acute angle-closure glaucoma

A

B-blockers
Acetazolamide
Pilocarpine

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29
Q

How can the medications for acute angle-closure glaucoma be remembered

A

BAP

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30
Q

What B-blocker is given in acute glaucoma and how

A

topical Timolol

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31
Q

What is the role of timolol

A

stops aqueous humour production

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32
Q

how is pilocarpine given

A

topical

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33
Q

what is the role of pilocarpine

A

causes pupil constriction = increasing iridocorneal angle

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34
Q

how is acetazolamide given

A

IV

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35
Q

what is the role of acetazolamide

A

stops aqueous humour production

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36
Q

in addition to 3 key medications, what may be offered for acute angle-closure glaucoma

A

anti-emetic

analgesia

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37
Q

what is the long-term management of acute angle-closure glaucoma

A

YAG laser peripheral iridectomy

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38
Q

what does laser peripheral iridectomy involve

A

Hole is cut into the iris at 12’O-clock enabling drainage

39
Q

what is the complication of angle-closure glaucoma

A

increase pressure can cause occlusion of central retinal artery or vein leading to blindness

40
Q

define open-angle glaucoma

A

optic neuropathy with death or retinal ganglion cells and their axons

41
Q

why is raised IOP not part of definition in open-angle glaucoma

A

as open-angle glaucoma can occur with both raised and normal IOP

42
Q

what is the second most common cause of blindness worldwide

A

open-angle glaucoma

43
Q

how does incidence of chronic glaucoma change with age

44
Q

what age does chronic glaucoma usually affect

45
Q

what are the four non-modifiable risk factors for open-angle glaucoma

A
  1. FH
  2. Age
  3. Afro-carribean
  4. Myopia (short-sighted)
46
Q

what are the 4 modifiable risk factors for open-angle glaucoma

A
  1. DM
  2. Corticosteroids
  3. HTN
  4. Raised IOP
47
Q

why is open-angle glaucoma often referred to as asymptomatic

A

As the visual field defect happens so progressively that patients often don’t notice it

48
Q

what is the ‘triad’ of signs/symptoms in angle-open glaucoma

A
  1. Raised IOP
  2. Visual field defect
  3. Cupping
49
Q

what is raised IOP

50
Q

why is cupping of the optic disc seen

A

Due to death of retinal ganglion cells in the neuroretinal rim

51
Q

what visual loss happens in open-angle glaucoma first

A

Peripheral field loss - usually of superior and nasal fields

52
Q

what is spared in open-angle glaucoma

A

Central vision

53
Q

how does increase IOP in open-angle glaucoma affect the optic nerve

A

Raised IOP causes atrophy of the outer rim - loss of peripheral vision and then causes further damage causes loss of central vision

54
Q

Explain optic disc cupping

A

Loss of disc substance. Makes cup appear larger. Which deepens, vessels emerging appear to have a ‘break’. Notching of the cup and dis may occur. The vessels are displaced nasally causing loss of superior and nasal fields.

55
Q

What is first-line to investigate open-angle glaucoma

A

automated perimetry - to look at visual field loss

56
Q

How can glaucoma be identified on automate perimetry

A

more than 3-locations outside of the individuals visual field

57
Q

Explain visual field loss on open-angle glaucoma

A
  1. Starts superior, nasal field loss
  2. Progresses to, temporal field loss
  3. Finally, central field loss
58
Q

Is open-angle glaucoma bilateral or unilateral

A

Bilateral. However, visual field defects may not be symmetrical

59
Q

What is second-line investigation for open-angle glaucoma

60
Q

What are 4 features of open-angle glaucoma on slit lamp

A
  1. Increased disc to cup ratio
  2. Pale optic disc
  3. Bayonneting of vessels
  4. Other - haemorrhages
61
Q

what causes optic disc cupping

A

Destruction of retinal ganglion cells - making disc appear smaller

62
Q

what is the optic disc to cup ratio in open-glaucoma

63
Q

why is the optic disc pale in open-angle glaucoma

A

Due to atrophy of optic disc

64
Q

what is bayoneting of vessels

A

As vessels dissapear into the cup - they appear to have breaks. More common inferiorly

65
Q

where does bayonetting of vessels usually occur

A

inferior cup

66
Q

what is third line investigation of glaucoma

67
Q

what does tonometry look at

68
Q

how does tonometry present in open-angle glaucoma

69
Q

why is screening for open angle glaucoma recommended

A

As it is usually asymptomatic - so individuals are unaware

70
Q

what does screening involve

A

tonometry, visual dields, optic disc exam

71
Q

what do NICE recommend for screening

A

individuals over 40 with a first-degree relative should receive screening

72
Q

once diagnosed, how often are individuals followed up

A

every 6m to deter damage

73
Q

explain aims of management in open-angle glaucoma

A

treatment will not improve vision, but it will prevent further deterioration.

74
Q

What two medications are given for open-angle glaucoma

A
  1. Prostaglandin analogue

2. B-blocker

75
Q

What prostaglandin analogue is given in open-angle glaucoma

A

Lantoprost

76
Q

What is the role of lanoprost

A

Increases outflow

77
Q

Apart from B-blockers, what two drugs are possible alternatives

A

Sympathomimetics

Carbonic anhydrase inhibitors

78
Q

If medication is ineffective, what treatment is considered

79
Q

What two surgical procedures can be offered for open-angle glaucoma

A
  • Trabeculoplasty

- Trabeculectomy

80
Q

What is trabeculoplasty

A

Surgical procedure to increase outflow of aqueous humour

81
Q

What medication is first-line in open-angle glaucoma

A

Prostaglandin analogue

82
Q

What are the roles of prostaglandin analogues

A

Decreases aqueous humour production

83
Q

What are 4 side-effects of prostaglandin analogues

A
  1. Longer eyelashes
  2. Brown pigmentation iris
  3. Peri-orbital pigmentation
  4. Red eye
84
Q

What is the MOA of B-blockers in glaucoma

A

Reduce production of aqueous humour

85
Q

What are 3 side-effects of topical b-blockers

A
  1. Dry eyes
  2. Corneal anaesthesia
  3. Tachycardia
86
Q

In what patients should topical B-blockers be given with care and why

A

HF and asthmatics = absorbed straight into circulation

87
Q

What is the role of carbonic anhydrase inhibitors

A

Decrease production aqueous humour

88
Q

What are side effects of carbonic anhydrase inhibitors

A

Lassitude
Dyspepsia
Hypokalaemia
Parasthesia

89
Q

When are carbonic anhydrase inhibitors contraindicated

90
Q

What is a side effect of sympathomimetics

A

Red-eye with loss of vision

91
Q

When should sympathomimetics definitely not be used and why

A

Angle-closure glaucoma. As sympathomimetics will cause dilation of the pupil - which will further obstruct trabecular meshwork

92
Q

What else needs to be considered in management of chronic glaucoma

A

DVLA contacted

93
Q

What is the uvea

A

middle-layer of the eye

Ophthalmology (12 decks)

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