17 - Glaucoma Flashcards
OHT
- definition
- risk factors for conversion to POAG (5)
IOP > 21 without nerve damage
IOP Race: AA 4-5x more Fam hx: first degree relative Age: >55 THIN CORNEA (<555) -lower risk with thick (>588)
POAG
Most common glauc
Nerve damage + IOP >21 + open angle
ISNT rule
Systemic assoc w/ port-wine stains (unil)
Secondary OAG
-types
Pseudoexfoliation syndrome (PX)
Pigmentary dispersion glaucoma (PD)
Pseudoexfoliation syndrome
Age-related systemic condition
Caucasians - esp Scandanavian
Abnormal, white, flaky deposits:
- iris/pupil margin
- anterior lens = bull’s eye pattern
- angle/TM
- Sampaolesi line = anterior to Schwalbe’s line
Assoc with poor pupil dilation, incr risk lens subluxation + ct sx complications (weak zonules)
Pigmentary dispersion syndrome
Bilateral
Caucasians, young (30-40s)
Myopes, males
High AC pressure -> iris bowing posteriorly (concave)
Blurred vision/halos after exercising
TIDs
Krukenberg’s spindles (vertical, corneal endo)
Anterior lens capsule + iris pigment
TM hyperpigmentation
Risk of glauc:
5 years = 10%
10 years = 15%
Angle recession glaucoma
Wide open angle with recessed CB band
Usually unilateral, due to blunt trauma
TM damage -> incr risk of glauc over time
10% of pts with angle recession involving 2/3 angle will develop glaucoma
NTG
NFL damage with pressures <21, open angle
Females, Japanese
VASCULAR issues: Raynauds, migraines, hypotension, sleep apnea, hypercoagulation, BP meds at bedtime (decr oc perf press)
Drance hemes
VFDs: focal, dense, and closure to fixation (nasal step, central)
Suspected unil NTG: hemorrhagic shock, MI, anemia, syphilis, vasculitis
Primary ACG
-pupillary block vs plateau iris syndrome
Acute or intermittent (subacute)
Pupillary block: hyperopes, older, advancing cataracts, Asians and Eskimos, lens subluxation, occludable angles
-most risk when pupil reaches mid-dilation
Plateau iris syndrome: much less common, CB issue - anteriorly positioned processes push periph iris forward, gonio/slit lamp show flat iris plane, normal central AC depth, but convex peripheral iris
ACG
-acute vs subacute
Acute: closure (no TM visible), acute high IOP (50-100), WITH SYMPTOMS
- vomiting, intense pain, headache, halos, nausea,
- hazy cornea, MID-DILATED PUPIL (ischemic sphincter muscle), ciliary flush, glaucomflecken
- e.g. Topamax
Subacute/chronic: episodes of high IOP WITHOUT SYMPTOMS
- more common
- expected with pts with occludable angles
- PAS or pigment splotching on TM
- progressive nerve damage
Secondary ACG
-types
NVG
Uveitic
Congenital
ICE syndromes
NVG
Most common cause 1) CRVO 2) DM
Most important sign to recognize/prevent is iris rubeosis
NVA is always accomp by fibrous tissue that forms a membrane over the TM
-membrane can stick to the iris -> pull it up to TM -> secondary closure (“zippering the angle”)
Uveitic glaucoma
PAS and PS formation in uveitis
PS only causes elev when there’s 360 degrees of attachment -> iris bombe and pupillary block
PAS causes varying degrees of elev, depending on extent of angle involvement
Iridocorneal endothelial (ICE) syndromes
Essential iris atrophy: iris thinning with resulting heterochromia, polycoria, corectopia, ectropion uvea
Chandler’s syndrome: corneal endo beaten metal app with edema, corectopia
Iris-nevus/Cogan-Reese syndrome: nodules present on anterior iris surface
Inflammatory glaucoma
-types
Glaucomatocyclitic crisis/Posner-Schlossman
Fuch’s heterochromic iridocyclitis
Phacolytic glaucoma
Glaucomatocyclitic crisis/Posner-Schlossman
HLA-B27 positive
IOP 40-60
Acute trabeculitis with mild AC rxn
Same as AACG but with open angle
