Anterior Chamber Disorders

Question 1

Open-Angle Glaucoma

Answer 1

Optic neuropathy results in progressive loss of retinal ganglion cell axons
Peripheral vision lost, then central, then blindness

Question 2

Open-Angle Glaucoma Risk factors

Answer 2

Age: 1% < 55, 2% at 65, 4% at 80
Race: higher in blacks
Family history
Elevated introcular pressure (IOP)
Others: DM, myopia, HTN

Question 3

Primary Open Angle Glaucoma Symptoms

Answer 3

rarely experienced
no loss of visual acuity as long as central vision is preserved
Some unaware of field loss even when it has progressed to central “tunnel vision” of 10-20 degrees

*Visual field loss cannot be recovered once it has occurred

Question 4

Primary Open Angle Glaucoma Fundoscopic Exam

Answer 4

Presence of cupping

A cup that is greater than 50 percent of the vertical disc

Question 5

Primary Angle-closure Glaucoma

Answer 5

narrowing or closure of the anterior chamber angle.
Results in narrowing or closure of the normal drainage pathway and aqueous humor builds up leading to elevated IOP.
This leads to damage of the optic nerve

Question 6

Primary Angle-closure Glaucoma Risk factors

Answer 6

Family history 
Age older than 40 or 50 years
Female
Hyperopia (farsightedness)
Medications—decongestants, antipsychotics, antidepressants 
Race—Inuit and Asian populations

Question 7

Chronic Glaucoma

Answer 7

Often asymptomatic

Diagnosis (in at least one eye):
Glaucomatous optic nerve damage (thinning, cupping or notching of the disc rim) AND the presence of characteristic abnormalities in the visual field in the absence of other causes for a field defect
Adult onset
Open, normal appearing anterior chamber angles

Question 8

IOP—Pressure Parameters for Referral

Answer 8

IOP > 40 mmHg—Emergency referral
IOP 30-40 mmHg—Urgent referral 
IOP 25-29 mmHg—Evaluation within 1 wk
IOP 23-24 mmHg—warrants repeat measurement to confirm and/or referral for comprehensive eye examination
NORMAL IOP = 12-20 mmHg

Question 9

The American Academy of Ophthalmology recommends screening for glaucoma as part of the comprehensive adult eye examination (measuring IOP, evaluating the optic nerve and testing for visual field defects)

Answer 9

Between ages 40-60 every 3-5 years for those WITHOUT risk factors
Every 1-2 years for those WITH risk factors
Suggests periodic exams for black men & women between ages 20-39

Question 10

Argon laser trabeculoplasty (ALT)

Answer 10

Improves drainage of fluid out of the eye

Question 11

Acute Angle-Closure Glaucoma Preexisting Factors

Answer 11

Elderly
Hyperopes
Inuits
Asians

Question 12

Acute Closed Angle Glaucoma symptoms

Answer 12

Rapid onset
Severe eye pain and HA
Profound visual loss with “halos around lights”
photophobia
Nausea and vomiting

***These patients are in distress, usually covering their eye or clutching their frontal region. Often the headache is accompanied with nausea and vomiting.

Question 13

Acute Closed Angle Glaucoma signs

Answer 13

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

Question 14

Uveitis

Answer 14

Nongranulomatous anterior uveitis is most often associated with HLA-B27 related conditions:
Ankylosing spondylitis
Reactive arthritis
Psoriasis
Ulcerative colitis
Crohn’s disease
Behçet’s syndrome causes anterior uveitis with recurrent hypopyon, no pain, and posterior uveitis with branch retinal vein occlusions

Question 15

Infectious Etiologies of Uveitis

Answer 15

CMV
Toxoplasmosis
Syphillis
Cat scratch disease
HSV & HZV

Question 16

Posterior Uveitis: Signs and Symptoms

Answer 16

Cells seen in the vitreous
Inflammatory lesions 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 17

Anterior Uveitis Symptoms

Answer 17

Eye pain
Redness
May have visual loss
Anterior uveitis 4 times more common then posterior

Question 18

Cataract Types

Answer 18

nuclear sclerosis
anterior subcapsular (trauma/radiation/electricity)
posterior subcapsular (DM, steroids)
Congenital
“Christmas Tree” cataract

Question 19

Pathophysiology of Cataracts

Answer 19

Lifelong growth of the lens produces stratified epithelia with a high content of cytoplasmic protein
The lens does not shed these epithelial cells and with age they can become opaque
Experimental evidence suggests photo-oxidative insult potentiated by toxic or sensitizing substances

Question 20

Leading cause of blindness in the WORLD

Answer 20

Cataracts

Question 21

Cataract Causes

Answer 21

Genetic predisposition/FHx
Age
Smoking (20% of the cataracts in U.S. caused by smoking)
Sunlight exposure
Steroids (including long term use of inhaled corticosteroids)
Diabetes mellitus