Acute Angle Closure Glaucoma

Question 1

Pathophysiology of acute angle closure glaucoma

Answer 1

Ophthalmological emergency

Iris bulges forward which seals off trabecular meshwork

Causing aqueous humour building up in posterior chamber

Leading to increased IOP

Question 2

Risk factors for acute angle closure glaucoma

Answer 2

Older age
Family history
Female
East Asian
Shorter eyeball (as causes shallow anterior chamber)
Hypermetropia
Drugs: anticholinergics, tricyclics, adrenergics

Question 3

Signs and symptoms of Acute angle closure glaucoma

Answer 3

Severe eye pain
Redness
Blurry vision
Rainbow coloured haloes
Headache
N+V

Signs:
Red eye
Unilateral Conjunctival injection
Hazy cornea
Decreased visual acuity
Mid dilated, fixed size pupil
Hard eyeball on palpation

Question 4

Acute management of acute angle closure glaucoma

Answer 4

Immediate admission
Lie patient on back without pillow
Pilocarpine eye drops
Acetazolamide 500mg oral
Analgesia
Antiemetic

Laser iridotomy definitive mx

Question 5

What is ARMD

Answer 5

Progressive condition affecting macula

Most common cause of blindness in UK

Two types: wet (neovascular) and dry (non neovascular - most common)

Question 6

Difference between wet and dry ARMD

Answer 6

Wet ARMD involves neovascularisation from choroid layer into retina triggered by VEGF leading to fluid leaking out causing faster vision loss. Worse prognosis. Presents more acutely

Dry ARMD has no neovascularisation, better prognosis. Presents less acutely

Question 7

Risk factors of ARMD

Answer 7

Older age
Smoking
FH
CV disease
Obesity
Poor diet lacking vitamins and high in fat

Question 8

Signs and symptoms of ARMD

Answer 8

Gradual central vision loss over 2-3 years
Bilateral eye sx in later stages
Inability to read small text
Metamorphopsia

Signs:
Reduced visual acuity
Scotoma
Metamorphopsia on Amsler grid test
Drusen on fundoscopy

Question 9

Investigations for ARMD

Answer 9

Snellen chart
Amsler grid test
Slit lamp examination to assess retina and macula
Optical coherence tomography
Fluorescein angiography to assess for oedema and neovascularisation

Question 10

Management of dry ARMD

Answer 10

Aim: slow progression of ARMD

Stop smoking
Control BP
Vitamin rich diet

Question 11

Management of wet ARMD

Answer 11

Aim: slow progression of ARMD

Stop smoking
Control BP
Vitamin rich diet
Anti VEGF medications

Question 12

Triggers of AACG

Answer 12

Think: AACG usually happens when pupil dilated
Pupil mid dilation from dark room
Tricyclics/SSRI
Topiramate
Anticholinergics
Pupil dilating drops

Question 13

Investigations for AACG

Answer 13

Goldmann application tonometry - measure IOP (above 30 in AACG)
Gonioscopy- measure anterior angle