Glaucoma

Question 1

What is the defintion of glaucoma?

Answer 1

increased intraocular pressure which results in damage to the retina and optic nerve

Question 2

What is the epi of glaucoma?

Answer 2

second leading cause of blindness in adults (following age-related macular degeneration)

Question 3

What are 2 main types of glaucoma?

Answer 3

open angle (90%) and angle closure glaucoma

Question 4

What is the angle referred to?

Answer 4

is the iridocorneal angle: angle between the iris and cornea

Question 5

What is the aetiology of open angle glaucoma?

Answer 5

1. Iridocorneal angle unaffected
2. Defect of the trabecular meshwork which slows down flow of aqueous humour
3. Chronic

Question 6

What are RF and epi for open angle glaucoma?

Answer 6

1. > 40 y/o
2. DM
3. FHx
4. African decent

Question 7

What are symptoms of open angle glaucoma?

Answer 7

1. Bilateral progressive (chronic) visual field loss)
2. Peripheral to central
3. Often asymptomatic

Question 8

What investigations are done for open angle glaucoma?

Answer 8

1. Tonometry

2. Fundoscopy

Question 9

What does tonometry show in open angle glaucoma?

Answer 9

check elevated intraocular pressure (only raised in 40% of open angle so not needed for DDx) – may get IOP>21mmHg

Question 10

What does fundoscopy show in open angle gluacoma?

Answer 10

increase in cupping of optic disc

Question 11

What is the medical managment for open angle gluacoma?

Answer 11

• Prostaglandin anlaogues (latanoprost, travoprost) which increase aqueous humour outflow
• Topical beta blocker: decrease aqueous production at ciliary body

Question 12

What do the prostoglandin analgoues do in open angle glaucoma?

Answer 12

increase aqueous humour outflow

Question 13

What do the topical beta blockers do in open angle glaucoma?

Answer 13

decrease aqueous production at ciliary body

Question 14

What is the surgical treatment for glaucoma?

Answer 14

Surgical trabeculectomy

Question 15

What is closed angle glaucoma also known as?

Answer 15

acute angle closure glaucoma

Question 16

What is the aeitology of closed angle glaucoma?

Answer 16

• Narrowing of iridocorneal angle, prevents aqueous flowing correctly into the trabecular meshwork
• MEDICAL EMERGENCY (acute)

Question 17

What are RF for closed angle glaucoma?

Answer 17

1. Old age

2. Mydriasis (drug-induced like anti-cholinergic e.g. atropine)

Question 18

What are symptoms for closed angle glaucoma?

Answer 18

1. Sudden onset
2. Photophobia
3. Eye redness
4. Severe pain
5. Headache
6. N+V

Question 19

What investigations are done for closed angle glaucoma?

Answer 19

1. Tonometry
2. Slit lamp
3. Gonioscopy
4. Fundoscopy
   - Dilated pupil unresponsive to light on one eye

Question 20

What does tonometry show in closed angle glaucoma?

Answer 20

IOP>21mmHg (30 in acute angle closure)

Question 21

What does slit lamp show in closed angle glaucoma?

Answer 21

narrowing/closure or iridocorneal angle

Question 22

What is gonioscopy?

Answer 22

gold standard test to assess the irdiocnreal angle is suspected angle closure glucaoma

Question 23

What does fundoscopy show in closed angle gluacoma?

Answer 23

increase in cupping of optic disc

Question 24

What is the management of closed angle gluacoma?

Answer 24

1. Emergency: need to lower IOP immediately
2. Topical beta blocker (timolol) decrease aqueous production
3. Carbonic anhydrase inhibitor (acetazolamide): decreases aqueous production
4. Ultimately need surgery to cure: high intensity laser treatment

Question 25

What is an example of a carbonic anhydrase inhbitor?

Answer 25

acetazolamide

Question 26

What does the topical beta blocker and carbonic anyhdrase inhibitor do in closed angle glaucoma?

Answer 26

decreases aqueous production

Question 27

What are examples of prostaglandin analogue in open angle glaucoma?

Answer 27

1. latanoprost

2. travoprost