CDA - Glaucoma Flashcards
What are some red flag indicators for headache?
- Sudden onset especially if no POH
- Severe debilitating pain +/- wakes at night
- Progressive
- Worse when bending, sneezing
- Worse in the morning
- young obese female (pseudotumor cerebri, IIH)
- new >50 years of age (Giant cell arteritis)
- history of recent trauma (IIH)
Red flag indicators for headache and associated symptoms?
- Fever (meningitis)
- Vomiting (IIH)
- migraine (IIH)
- Seizures (epilepsy, haemorrhage, infection)
- diplopia, CN palsy, blurry VA –> GCA, IIH, stroke)
What tests would you do for a patient with a headache?
Vision, VA
Pupils
Colour vision (Ishihara)
Dilated Fundus examination, optic nerve assessment
Visual field –> associated IIH, papilledema, optic atrophy/ neuropathy
OCT –> IIH, Papilledema, optic atropy, optic neuropathy
List some DDx for a patient c/o “blurry vision in both eyes and headaches”
Patient is a 31y.o Female
Obese
- Bilateral optic nerve swelling
- IIH
- Papilledema
- Severe hypertension
- Papillitis
- Optic neuritis
- Optic nerve glioma
- Acute angle closure glaucoma
- Glaucoma suspect
31 year-old female social worker who presents with 2 month history of fluctuating vision in both eyes. The blurriness has become more permanent in the R>L for the last 3 weeks. Vision is worse when lying down; at times her vision goes completely dark in both eyes. Patient denies flashes or floaters. She has noticed some diplopia side to side when watching TV, occasionally, in the last 3 months.
She also reports headaches - intense and persistent- over her whole head for the last month. She though maybe due to the blurry vision. Headaches are also worse when lying down. She can also hear a whooshing sound in her ears once-in-a-while “as if I was listen to the waves”.
List the more likely DDx
- Inner ear infection
- IIH
- Optic nerve head swelling
Papillitis
Severe hypertension
Further history and results:
VA reduced in LE 6/60 and RE 6/6
L RAPD present
Nil other POH, GH,
CT D and N: //
VF: significant decrease of VF in OU with preserved central vision
MRI: large supraselllar mass abutting the R optic nerve and displacing the L optic nerve
Diagnosis
Bilateral optic nerve head swelling, due to intracranial mass
Tx: referral and evaluation by neurosurgeon.
Acetazolamide (Diamox) to reduce the intracranial pressure
Lifelong permanent vision loss
Define glaucoma
Optic atrophy
Optic neuropathy with progressive ONH damage and characteristic VF loss
What is the 1 modifiable factor you can change with glaucoma?
IOP
How would you explain this?
Where would the subsequent VF loss be at?
It is glaucomatous ONH
C/D 0.8
the arrow points to a notch (remember: the inferior and superior poles of the ONH show signs of atrophy first)
VF loss –> superior arcuate loss
Are these two ONH glaucomatous?
NO
They are normal ONH because:
- we need to factor in the neuroretinal rim and ask ourselves does it follow the ISNT rule
- the ISNT rule: the rim is thickest at its inferior, superior, nasal and temporal.
- if the ONH follows the ISNT rule, then it isnt glaucomatous (Does not apply to all cases, but most)
Which field represents the L VF and R VF?
How far does the normal VF extend superiorly, inferiorly, nasally and temporally?
How far away from the centre is the blind spot?
The blind spot is approx 15 degrees temporal to the centre.
Overview of VF loss and how a nasal step can become much worse if left untreated
What is this?
Where is it found more often?
Sampaolesi line
Line of pigment present anterior (above on gionioscopy) to Schwalbe’s line in the angle.
It is more common in PXS (pseudoexfoliation syndrome) and less in pigment dispersion syndrome.
What is this?
Where is it more commonly found?
Scheie stripe
More commonly found in PDS/PG.
Pathogonomonic
What is this?
Where is it found?
Fibrillar material on anterior capsule in a target like distribution.
More so in PXS
The movement of iris across the capsule as the pupil dilates and constricts –> causes distribution of the material
The difference between PXS and PDS/PG
