Glaucoma

Question 1

What are the risk factors for open-angle glaucoma?

Answer 1

• Age >40
• African descent
• Diabetes
• Myopia
• +ve FHx

Question 2

What are the clinical features of open-angle glaucoma?

Answer 2

• Initially often asymptomatic

- Bilateral, progressive visual field loss (peripheral –> central)

Question 3

What are findings on fundoscopy and slit-lamp examination are typical of open-angle glaucoma?

Answer 3

1. Fundoscopy:
   - Cupping and pallor of optic disc
   - Disc haemorrhage
   - Diffuse or focal narrowing of the optic disc rim
2. Slit-lamp:
   - normal appearing anterior chamber angle

Question 4

What are the 1st line treatments of open-angle glaucoma?

Answer 4

• Prostaglandin eye drops (latanoprost)

- Laser trabeculoplasty

Question 5

What are the risk factors for angle-closure glaucoma?

Answer 5

• Asian descent

- Mydriasis (including mydriatic drugs like atropine)

Question 6

What are the clinical features of angle-closure glaucoma?

Answer 6

• Sudden onset
• Unilateral red, hard, and severely painful eye
• Frontal headaches
• Vomiting, nausea
• Steamy cornea and blurred vision, reduced visual acuity
• Dilated, non-reactive pupil

Question 7

What is the initial management of acute angle-closure glaucoma (i.e. if immediate admission is not possible)?

Answer 7

• Lay the person flat with their face up and head unsupported (no pillows)
• Pilocarpine eye drops (2% in blue eyes and 4% in brown eyes)
• Acetazolamide 500mg orally
• Analgesia
• Anti-emetic

Question 8

What is curative treatment of acute angle-closure glaucoma?

Answer 8

Laser peripheral iridotomy