Anterior Chamber Disorders Flashcards
Open-Angle Glaucoma
Optic neuropathy results in progressive loss of retinal ganglion cell axons
Peripheral vision lost, then central, then blindness
Open-Angle Glaucoma Risk factors
Age: 1% < 55, 2% at 65, 4% at 80 Race: higher in blacks Family history Elevated introcular pressure (IOP) Others: DM, myopia, HTN
Primary Open Angle Glaucoma Symptoms
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
Primary Open Angle Glaucoma Fundoscopic Exam
Presence of cupping
A cup that is greater than 50 percent of the vertical disc
Primary Angle-closure Glaucoma
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
Primary Angle-closure Glaucoma Risk factors
Family history Age older than 40 or 50 years Female Hyperopia (farsightedness) Medications—decongestants, antipsychotics, antidepressants Race—Inuit and Asian populations
Chronic Glaucoma
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
IOP—Pressure Parameters for Referral
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
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)
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
Argon laser trabeculoplasty (ALT)
Improves drainage of fluid out of the eye
Acute Angle-Closure Glaucoma Preexisting Factors
Elderly
Hyperopes
Inuits
Asians
Acute Closed Angle Glaucoma symptoms
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.
Acute Closed Angle Glaucoma signs
Conjunctival redness (red eye)
Cornea edema or cloudiness
Shallow anterior chamber
Mid-dilated pupil that reacts poorly to light
Uveitis
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
Infectious Etiologies of Uveitis
CMV Toxoplasmosis Syphillis Cat scratch disease HSV & HZV
