Anterior Chamber Disorders

Question 1

Glaucoma

Answer 1

2nd leading cause of blindness in the world (behind cataracts)

Question 2

Types of Glaucoma

Answer 2

Open-angle glaucoma (progressive loss of retinal ganglion axons). Angle-closure glaucoma (the anterior angle narrows). Acute angle-closure glaucoma

Question 3

Open-angle glaucoma

Answer 3

Optic neuropathy results in progressive loss of retinal ganglion cell axons (painless vision loss, macular degeneration). Peripheral visual fields lost first, then central vision, it then progresses to blindness

Question 4

Angle-closure glaucoma

Answer 4

Anterior chamber angle closes the normal drainage pathway of the aqueous humor which then builds up leading to elevated IOP

Question 5

Chronic Glaucoma

Answer 5

Primary, progressive excavation (“cupping”) and pallor of optic disk. Progressive loss of vision from slight constriction of peripheral fields  complete blindness

Question 6

IOP

Answer 6

Normal range 12-20

IOP > 40 mmHg—Emergency referral
IOP 30-40 mmHg—Urgent referral (within 24 hrs) if no symptoms suggesting acute glaucoma
IOP 25-29 mmHg—Evaluation within 1 wk
IOP 23-24 mmHg—warrants repeat

Question 7

Glaucoma treatment

Answer 7

Medications (“eyedrops”)
Laser surgery
Incisional surgery

Question 8

Acute angle-closure glaucoma

Answer 8

Acute angle closure may be precipitated by pupillary dilation (dark theater). Rapid onset. Severe eye pain and HA. Profound visual loss with “halos around lights.” May have photophobia. Nausea and vomiting. This is an emergency! Acetazolamide and refer.

Question 9

Uveitis

Answer 9

Intraocular inflammation. Often associated with HLA-B27: Ankylosing spondylitis, Reactive arthritis (related to gonorrhea/chlamydia), Psoriasis, Ulcerative colitis – GI problem, bowel issue, Crohn’s disease

Question 10

Etiologies of Uveitis

Answer 10

CMV, Toxoplasmosis, Syphillis, Cat scratch disease, HSV & HZV

Question 11

Anterior Uveitis (iritis) symptoms

Answer 11

Eye pain, Redness, May have visual loss, Anterior uveitis 4 times more common then posterior, May be seen together–panuveitis

Question 12

Posterior Uveitis signs and symptoms

Answer 12

Cells seen in the vitreous, Inflammatory lesions may be seen on retina or choroid. Fresh lesions are yellow while older lesions are pigmented. Usually presents with gradual vision loss. Bilateral involvement is common. Usually painless unless anterior involvement

Question 13

Iritis signs and symptoms

Answer 13

Deep eye pain. Photophobia. Redness. Ciliary flush
Pupillary constriction. Unilateral or bilateral
“Keratic precepitates” may collect in clusters on the posterior cornea. Synechiae can form

Question 14

complications of Iritis

Answer 14

Cataracts. Calcifications in the cornea. Glaucoma.

Uveitis. Permanent vision imipairment. Blindness

Question 15

Hyphema

Answer 15

when RBCs form a suspension in aqueous humor.
Grade 1 - Layered blood occupying less than one third of the anterior chamber. Grade 2 - Blood filling one third to one half of the anterior chamber. Grade 3 - Layered blood filling one half to less than total of the anterior chamber. Grade 4 - Total clotted blood, often referred to as blackball or 8-ball hyphema

Question 16

Hypopyon

Answer 16

The presence of pus or a puslike fluid in the anterior chamber of the eye. It may occur as a complication of a penetrating wound to the eye, conjunctivitis, herpetic keratitis, or corneal ulcer.

Question 17

Cataracts

Answer 17

Leading cause of blindness in the world. Opacity of the lens of the eye that causes partial or total blindness. Painless, typically bilateral.

Question 18

What does the presence of cupping indicate on fundoscopic exam?

Answer 18

A cup that is greater than 50 percent of the vertical disc diameter is a useful threshold for suspicion of glaucoma.

Question 19

What are signs of acute closed angle glaucoma?

Answer 19

Conjunctival redness (red eye). Cornea edema or cloudiness. Shallow anterior chamber. Mid-dilated pupil that reacts poorly to light

Question 20

How does acetazolamide (a carbonic anhydrase inhibitor) work?

Answer 20

decreases the secretion of aqueous humor and results in a drop in intraocular pressure

Question 21

What is treatment of uveitis due to infection?

Answer 21

Antiviral agent + topical glucocorticoids. Appropriate antibiotics for bacterial infections

Question 22

What is treatment of anterior noninfectious uveitis?

Answer 22

topical glucocorticoids + dilating drop (scopalamine or cyclopentolate).

Question 23

What is treatment of posterior noninfectious uveitis?

Answer 23

periocular injection of triamcinolone and if resistant inflammation systemic corticosteroids

Question 24

What is the work up for a hyphema?

Answer 24

Visual acuity. IOP. Slit lamp. CT if severe trauma

Question 25

What meds should you give for a hyphema?

Answer 25

Drops of 1% atropine may be prescribed. Steroid drops and NSAID may also be prescribed to fight inflammation and pain. Beta blockers if IOP increases

Question 26

Describe cataract surgery

Answer 26

phacoemulsification-use ultrasound and vacuum to remove lens. lens implant (plastic or silacone). Patient is put on glucocorticoid and NSAID topical eyedrops after surgery