Chronic Glaucoma

Question 1

What is chronic glaucoma?

Answer 1

Degeneration of retinal ganglion cells which form the optic nerve (i.e. an optic neuropathy)

Question 2

Risk factors for chronic glaucoma

Answer 2

Age is main risk factor

African, Caribbean

Myopia

Only modifiable risk factor is intra-ocular pressure (IOP) and is the focus of treatment

Question 3

Clinical features of chronic glaucoma

Answer 3

Raised IOP

Optic disc changes (cupping)

Visual field defects

Question 4

Intraocular pressure in chronic glaucoma

Answer 4

Usually >21

Typically >25-30

Question 5

What is “cupping”?

Answer 5

Progressive thinning of the neuroretinal rim of the disc due to loss of RGCs

Question 6

Screening for chronic glaucoma

Answer 6

Usually asymptomatic

Screened for by opticians

Anyone >40 or with first-degree relative

Question 7

Driving and chronic glaucoma

Answer 7

Field loss means patient cannot legally drive

DVLA must be informed of diagnosis

Question 8

Treatment aims in chronic glaucoma

Answer 8

Aimed at altering dynamics of aqueous fluid to lower IOP

Slows progression of disease, doesn’t reverse damage already done

Question 9

Management of chronic glaucoma

Answer 9

Prostaglandin analogue drops (e.g. g latanoprost) increase outflow of aqueous

Beta-blocker drops (e.g. g timolol) reduce production of aqueous

If drops don’t work, surgery (eg trabeculectomy) can be done

Question 10

Side effects of prostaglandin analogues

Answer 10

Longer eyelashes

Darker iris

Question 11

Side effects of beta blocker drops

Answer 11

Systemic beta blocker side effects (respiratory, cardiac) can occur