Clinical presentation and diagnosis

Question 1

RF for POAG?

Answer 1

1. elevated IOP
2. fam history glaucoma
3. older age
4. thinner central corneal thickness
5. type 2 DM
6. lower ocular perfusion pressures
7. myopia

Question 2

RF for PACG?

Answer 2

1. advance age
2. female sex
3. hyperopia
4. shallow anterior chamber
5. family history angle-closure glaucoma

Question 3

Development of PACG?

Answer 3

1. lead to shallow anterior chambers
2. thick , anterior displaced lens –> due to continued growth of lens / cataractous changes
3. anterior chamber - shallower - anatomically narrower iridocorneal inlets - set-up for developing narrow angles more susceptible to closure

Question 4

How are people with PACG characterised?

Answer 4

• 180 degree iridotrabecular contact
  2. elevated IOP
  3. opthalmic examination of glaucomatous chhanges

Question 5

what can reccurent attacks/ prolonged acute attack lead to ?

Answer 5

development of peripehral anterior synechia

- obstruct flow of aq humour through trabecular meshwork

Question 6

General for POAG

Answer 6

• adult > 40 age
• patients unaware have lgaucoma
• bilaterla - asymmetric disease progression

Question 7

symptoms of POAG

Answer 7

• severe disease progress to loss peripheral vision - tunnel vision
• presence paracentral , nasal + arcuate scotoma in vield of vision

Question 8

signs of POAG

- opthalmoscopic examinations may reveal

Answer 8

• optic disc cupping
• large cup-to-disc ration
• diffuse thinning, focal narrowing/ notching optic disc rim
• splinter hameoorhage
• optic disc/ nerve fibre layer changes - before visual changes can be detected

Question 9

Diagnostic tests POAG

Answer 9

1. Gonioscopy - anterior chamber angles are to be open
2. Applanation tonometry - elevated IOP , signs optic neuropathy without elevated IOP
3. Pachymetry - measure central corneal thickness’- thin corneas are RF
4. Automated static threshold perimetry - evulate visual fields - detect defects in visual field before patient notic
5. other tests
   - scanning laser polarimetry
   - confocal scanning laser opthalmoscopy
   - optical coherence tomography

Question 10

General PACG

Answer 10

• medical emergenct - high risk vision loss

- unilaeral - fellow eye is at risk

Question 11

symptoms of PACG

Answer 11

• ocular pain
• red eye
• blurred vision
• halos around lights
• systemic symptoms may develop - N + V, abnominal pain, headache , diaphoresis

Question 12

Signs of PACG

Answer 12

• cloudy cornea caused by corneal odema
• conjuctival hyperaemia
  0 pupil semidilated + fixed to light
• eye will be harder on palpation through closed eye

Question 13

Diagnostic tests for PACG

Answer 13

1. Gonioscopy - anterior chamber angles closed
   - peripheral anterior synechiae present
2. applanation tonometry - elevated IOP , symptoms present IOP high
3. slit-lamp biomicoscopy - reveals shallow anterior chamber dept
   - signs previous attacks - peripheral anterior synechiae , iris atrophy, pupillary dysfunction