Glaucoma Flashcards
Strong RF for Glaucoma
SHIBA
S - Steroids H - Heritage I - IOP B - Blacks A - Age (+40)
Weak RF for Glaucoma
My Sweet Hyp!
My - Myopia
Sweet - DM
Hyp - HTN
Primary Open-angle glaucoma appears in _____% of the population above the age of 45.
0.5-1%
Ocular HTN w/o glaucoma appears in _____% of the population above the age of 45.
10%
RF for transition from Ocular w/o glaucoma HTN to Glaucoma are:
PIRAT
P - PSD increase (Pattern of standard deviation)
I - IOP (the higher the riskier)
R - Ratio (cup to dick ratio - CDR, normal is 0/3)
A - Age
T - Thin CCT (Central corneal thickness)
Thick cornea - IOP pressure recorded is ____than the truth
Thin cornea - IOP pressure recorded is ____than the truth
Thick cornea -> IOP pressure recorded is lower than the truth
Thin cornea -> IOP pressure recorded is higher than the truth
When treating a glaucoma patient we have to determine his individual_______.
Target pressure.
Target pressure is ______
20% below the pressure known to cause damage.
___% of glaucoma patients will have a normal exam on their first doctor’s appointment
30%
An increase in IOP causes cupping on the ____ aspect of the disc.
inferior
What are the mechanisms (or theories) of high IOP causing glaucoma?
Mechanical and Avascular.
Mechanisms (or theories) of high IOP causing glaucoma - elaborate on the mechanical mechanism.
Increase IOP presses on nerve fibers passing through the scleral canal (exit point out of the eye) -> disrupts axoplasmic flow -> atrophy
Mechanisms (or theories) of high IOP causing glaucoma - elaborate on the avascular mechanism.
Increase IOP harms ocular perfusion -> ischemia and atrophy.
Blood pressure issues may cause _____ that may lead to retinal ganglion cell death.
nocturnal BP dip and ischemia
Every glaucoma patient goes through _____
Visual field testing (for potential damage assessment)
When examining a with a Goldman goniolens we pay attention to____
Pigmented trabecular meshwork.
Explain the grading system of the proximity of the iris to the Pigmented trabecular meshwork.
0-4
0 = no filtering (completely blocked)
1 = partily blocked
Explain the grading system of the proximity of the iris to the Pigmented trabecular meshwork.
0-4
0 = no filtering (completely blocked - angle closure)
1 = partially blocked
______ are cells that clean the Pigmented trabecular meshwork.
Goniocytes.
Classification of glaucoma:
CaPSiD
Ca - Closed-angle P -Primary open-angle i S - Secondary D - Developmental
Classification of glaucoma - subdivide Primary open-angle glaucoma:
PEN:
P - Pigment
E - Exfoliation
N - Normal tension
Normal tension glaucoma pathophysiology:
Oversensitivity to tension and/or malperfusion.
Pigmentary glaucoma finding:
Transillumination in mid-periphery iris.
Closed-angle glaucoma pathophysiology:
Pupillary block combined with a narrow-angle, to begin with.
______ are seen on chronic closed-angle glaucoma
Anterior synechia
Classification of glaucoma - subdivide Developmental glaucoma:
Primary developmental - seen at birth (0-3 months)
Infantile - 3 months to 3 years.
Juvenile - 3 to 35 years.
Classification of glaucoma - subdivide Secondary glaucoma:
HD PAINT
H - Hemorrhage (clots)
D - Drugs (steroids)
P - Phacogenic A - Absolute I - Inflammatory N - Neovascular T - Trauma (and scars)
Subdivide phacogenic glaucoma:
Mature cataract (pushes iris forword) or subluxation of the lens (pupillary block -> iris moved forward).
What is absolute glaucoma?
condition of complete atrophy and blindness due to uncontrollable IOP from an unknown reason.
IOP of ____ can cause closure of the retinal artery.
60-70
sign of acute angle closer glaucoma:
Fixed PHoNER
Fixed - Fixed mid dilated pupil
P - Pain (eyes and head) H - Halos o N - Nausea/vomiting E - Endothelial pump dysfunction (blurry vision) R - Redness
Fixed mid dilated pupil in acute angle closer glaucoma is due to
sphincter papillae unreactive due to ischemia
Treatment of acute angle closer glaucoma:
CHeaP Laser!
C - CAI (Aqueous production decrease)
H - Hyperosmotics (IV mannitol - if vomiting, PO glycerol)
P - Pilocarpine (Miosis - sphincter papillae)
Day after - Yag laser.
All thee CHeaP drugs are given at the same time!
Pilocarpine usage:
3-4 times every 10 minutes, may not react immediately because of ischemic sphincter papillae. As IOP starts to drop, the drug will take effect.
Describe Goniodysgenesis
Dysgenesis trabecular meshwork. - looks open but the function is impared.
Congenital glaucoma epidemiology:
Incidence?
M: F?
Bilateral?
Congenital glaucoma epidemiology:
Incidence - 1:10,000 (90% sporadic)
M: F - 65% Boys
Bilateral in 75%
Congenital glaucoma signs:
BiSHoPED: Buphthalmos i S - Spasm (Blepharospasm) H - Hazy large cornea o P - Photophobia E - Epiphora D - Decrement tears
Congenital glaucoma treatment:
Surgical!
Trabeculectomy or Goniotomy
watch shot animation!
Common scotoma in glaucoma is _____
Paracentral
Paracentral scotomas can develop into
Archoid
Contraindications of BB therapy?
ABC
A - Asthma/ AV block
B - Bradycardia
C - COPD
BB therapy drug commonly used? and characteristics?
Timolol - rule of 0.5:
usually 0.5 %
Begins to work after 0.5 hour for 0.5 a day
The peak is at 2 hours. decease IOP by 25%
Lasers used in glaucoma therapy?
Yag, ALT. SLT
Drug of choice for open-angle glaucoma?
Prostaglandins.
Lasers used in glaucoma therapy characteristics?
The effect lasts for 2 years, with maximum effect after 2 months.
IOP decrease is about 9 mm
angle has to be open to perform procedure
Surgeries used in glaucoma therapy?
TIC!
T - trabeculectomy (filtration)
I - Implant
C - ciliary body ablation
watch shot animation!
