Glaucoma

Question 1

What is glaucoma?

Answer 1

Damage to the optic nerve caused by raised intraocular pressure

Question 2

Name the different types of glaucoma

Answer 2

Two types:
Open angle glaucoma
Closed angle glaucoma

Question 3

What value is classed as intraocular hypertension?

Answer 3

> 21 mmHg

Question 4

Describe the pathophysiology of open and closed angle glaucoma

Answer 4

• Both caused by a build up of aqueous humour
• In open angle glaucoma this is chronic
• In closed angle glaucoma this is acute

Question 5

Aqueous humour is produced by…

Answer 5

The ciliary body

Question 6

Aqueous humour drains through… and into… where it is reabsorbed into the general circulation

Answer 6

Aqueous humour drains through the trabecular meshwork and into the Canal of Schlemm where it is reabsorbed into the general circulation

Question 7

Open angle glaucoma is often asymptomatic. True or false?

Answer 7

True

Question 8

If any, what are the typical symptoms/signs of open angle glaucoma?

Answer 8

• Peripheral vision loss (‘tunnel vision’)

- Halos around lights

Question 9

Give a risk factor for developing glaucoma

Answer 9

Family history

Question 10

What is the name of the gold standard technique to measure intraocular pressure?

Answer 10

Goldmann applanation tonometry

Question 11

Treatment for open angle glaucoma is usually started at an intraocular pressure of… and above

Answer 11

24 mmHg

Question 12

What is the first line treatment for open angle glaucoma? How does it work? What are its side effects?

Are there other (medical) treatment options? How do they work?

Answer 12

First line = prostaglandin analogue eyedrops, e.g. latanoprost, which work by increasing drainage of aqueous humour. Side effects include eyelash growth and iris pigmentation (brown).

Other treatment options (eyedrops):

• Beta blockers, e.g. timolol
• Carbonic anhydrase inhibitors, e.g. dorzolamide
• These both work by reducing the production of aqueous humour

Question 13

Which procedure may be used if eyedrops are ineffective?

Answer 13

Trabeculectomy (creating a new pathway for aqueous humour to drain)

Question 14

What are the typical symptoms/signs of closed angle glaucoma?

Answer 14

• (severely) Painful red eye
• Halos around lights
• Nausea and vomiting

Question 15

Which medications may precipitate closed angle glaucoma?

Answer 15

Anticholinergic medications, e.g. oxybutynin, solifenacin, amitriptyline

Question 16

Describe the medical and interventional management of closed angle glaucoma

Answer 16

Medical:

• Pilocarpine eyedrops (2% for blue eyes, 4% for brown)
• Acetazolamide

Interventional
- Laser iridotomy (definitive)

Question 17

Does acute angle closure glaucoma present with…

a) Constricted pupil, or
b) Dilated pupil?

Answer 17

Dilated pupil