Clinical Evaluation of Glaucoma Flashcards
What specific symptoms should you ask about when taking the history of a glaucoma patient?
- Pain
- Redness
- Colored halos around lights
- altered/loss of vision
What glaucoma-associated condition are hyperopic eyes at risk for? Myopic eyes?
Hyperopic eyes are at risk for angle closure
Myopic eyes at risk for Pigment dispersion syndrome
What are s/sx of Tuberous Sclerosis ( Bourneville Syndrome)? What aspects of this disease may lead to glaucoma?
P/w ash leaf spots (hypo pigmented cutaneous legions) and adenoma sebaceum (red-brown papular rash on face and chin)
Glaucoma may occur 2/2 vitreous hemorrhage, anterior segment NV, or RDs
What is the hallmark symptom of Neurofibromatosis Type 1? What symptom is strongly associated with glaucoma?
Subcuntaneous plexiform neuromas are hallmarks
If located in eyelid, produce an “S-shaped” upper eyelid deformity, which is strongly associated with anterior segment abnormalities and glaucoma
What is the hallmark symptom of Juvenile Xanthogranuloma? What kind of glaucoma can it cause?
yellow/orange papules occur on skin of head/neck
may cause secondary glaucoma
What is the hallmark finding of oculocutaneous melanocytosis? What is another name for it? What conditions does it predispose to?
aka Nevus of Ota
Hallmark finding is hyper pigmentation of periocular skin
Associated with increased risk of intraocular pigmentation and secondary glaucoma, as well as melanoma
What is Axenfeld-Rieger Syndrome? What is its inheritance pattern? How is it related to glaucoma?
AD Inheritence
associated with microdontia, hypodontia, or adontia; anteriorly displaced schwalbes line
50% of patients in late childhood/adulthood develop glaucoma
What are the symptoms of developmental glaucoma?
Enlargement of the cornea and breaks in descemets membrane (Haab striae)
What is the hallmark finding in Pigment Dispersion Syndrome (PDS)
Krukenberg Spindle= vertical column of pigment located on lens/cornea
What is the hallmark finding in Pseudoexfoliation syndrome?
Sampoalesi Line= line of pigment anterior to schwalbes line
What is the hallmark sign of Uveitic Glaucoma?
Keratic precipitates
What is the hallmark finding in posterior polymorphous dystrophy?
Irregular and vesicular lesions
What is the classic finding in Iridocorneal Endothelial Syndrome (ICE)?
cornea with a “beaten bronze” appearance
What is a classic finding in Axenfeld-Rieger syndrome?
anterior displacement of schwalbes lines
Why is a goniolens required to view the angle of the eye?
Goniolens is required, b/c under nl conditions, light reflected from angle structures undergoes total internal reflection at the tear-air interface
This occurs b/c the critical angle (around 46 degrees) is achieved, and the light is totally reflected back into the corneal stroma
The goniolens eliminates the tear-air interface, and therefore allows visualization of the angle structures
What is dynamic gonioscopy?
during gonioscopy, gentle pressure is placed on the cornea using the lens, forced aqueous humor into the angle
When angle closure is present, what image do you see via goniolens?
The TM is no longer visible due to the peripheral iris obstructing the TM
What does the Shaffer system for describing an angle measure?
The angle b/w TM and Iris
What parameters does the Spaeth grading system take into account?
Contour of the peripheral Iris, angle b/w the iris and cornea, and location of iris insertion
Also takes into account effect of dynamic gonioscopy
When does blood enter schlemms canal?
In situations where episcleral venous pressure (EVP) is greater than IOP
What do angle vessels look like in neovascular glaucoma?
Vessels appear “trunk-like”, cross the CB and scleral spur, and arborize over the TM
What part of the angle is usually most pigmented?
The inferior portion, due to gravity
What is the difference between angle pigmentation in PDS compared to Pseudoexfoliation syndrome?
In PDS, there is uniform pigmentation of angle
In pseudoexfoliation syndrome, there is patchy pigmentation of the angle as well as sampoalesi lines (line of pigment anterior to schwalbes line)
What are the criteria for angle recession?
- abnormally wide CB band
- increased prominence of scleral spur
- torn iris processes
- marked variation of CB band
What is cyclodialysis?
separation of the CB from the scleral spur
Gonio-> deep angle recess with gap b/w CB and scleral spur
How many retinal ganglion cells/axons make up the optic nerve?
1.2-1.5 x 10^ 6 retinal ganglion cells
Cell bodies located in retinal ganglion cell layer (below nerve fiber layer)
What is the average diameter of the optic nerve head (ONH)? After leaving the orbit, what happens to the diameter?
1.5-1.7 mm in diameter
After exiting the lamina cribosa, the ON expands to 3-4 mm in diameter (difference being the myelination that forms retrolaminarly)
What are the three major cell types found in the retinal ganglion cell layer?
Magnocellular Neurons (M Cells) Parvocellular Neurons (P Cells) Koniocellular Neurons (Bistratified Cells)
What are the M Cells? What are some of their characteristics?
Have the largest axonal diameter
Synapse in the magnocellular layer of the LGN
Sensitive to luminance changes (scotopic changes)
Have the largest dendritic field
Primarily processes info related to movement
What are the P Cells? What are some of their characteristics?
Account for 80% of RGC layer
Concentrated in the central retina
Smaller axons and smaller receptive fields
slower conductive velocity
Synapse in parvocellular layer of LGN
Discriminate fine detail (high resolution vision)
What are the bistratified cells?
Neurons that process information regarding blue-yellow color discrimination
What percentage of the RGC layer do M and bistratified cells comprise?
10%