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ENT, neuro, eyes > Glaucoma > Flashcards

Glaucoma Flashcards

1
Q

What is the optic disc

A

where all the retinal nerve fibres converge to exit the eye in the optic nerve.

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2
Q

What field defect would you expect if a patient developed damage to the nerve fibres at 12 o’clock on the optic nerve?

A

An inferior arcuate loss. (superior retina corresponds to inferior part of visual field)

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3
Q

wHAT IS GLAUCOMA

A

Progresssive optic neuropathy causing specific optic nerve abnormailites - optic disc cupping - and field defects - arcuate field defects

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4
Q

Signs of glaucoma

A

Optic disc cupping
Field defects
Raised IOP

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5
Q

Why does the cup get bigger in glaucoma

A

Lose retinal nerve fibres - these axons degenerate, neuro-retinal rim shrinks (width around the disc) → cup gets bigger

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6
Q

Normal cup disc ratio

A

less than 0.5

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7
Q

What is most common field loss in glaucoma and why?

A

Arcuate - loss of inf (first to be dmaaged) or sup nerve fibres

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8
Q

How is IOP maintained

A

Ciliary body -> aqeous -> ant chamber eye
Trabecular meshwork in drainage angle -> schlemms canal -> venous system

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9
Q

Normal IOP

A

14-22 mmHg

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10
Q

Why is rais IOP ass w glaucoma?

A

Raised IOP casues damage to nerve fibre layer and optic disc → visual defects = glaucoma

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11
Q

Conditions when IOP and glaucoma unrelated

A

(If no damage -> ocular HPTN, damage w normal IOP - normal tension glaucoma)

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12
Q

What causes primary open angle glaucoma?

A

Blockage in trabecular meshawork or Schlemms canal causes IOP to rise

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13
Q

Which glaucomas are painful?

A

Acute angle closure glaucoma, uveitis, acute rubeotic glaucoma

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14
Q

Treatment for acute angle closure glaucoma

A

IV Diamox, pilocarpine drops, followed by laser treatment (prevents recurrence)

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15
Q

Drugs causing acute angle closure glaucoma

A

anti-depressants, anti-psychotics, anti-epileptics, benzodiazepines, asthma and GORD drugs, pupil dilators for fundoscopy

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16
Q

Symptoms of acute angle closure glaucoma

A

acute rise in pressure. This is acutely painful, is red, the patient often feels systemically unwell and their vision deteriorates.

17
Q

Congenital glaucoma

A

“buphthalmos
Cloudy cornea
Intense photophobia
Blepharospasm
Watering eyes

18
Q

Why review ocular HPTN?

A

10% chance of becoming primary angle glauocoma

19
Q

Risk factors for normal tension glaucoma

A

Migraine, raynauds, women

20
Q

Gold standard for glaucoma investiaggtion

A

Goldmann tonometer

21
Q

Investigations ofr glaucoma

A

Goldmann tonometer
Gonioscopy
Optical cpherence tomography

22
Q

What is gonioscopy?

A

View angle structure with mirrored lens

23
Q

What does Optical coherence tomography (OCT) assess

A

Objective measurements of disc cupping
Assess nerve fibre layer
OCT highlights areas where the nerve fibre layer and optic disc rim are thinned in comparison to normal data, monitor progression of disc cupping

24
Q

Benefits of OCT

A

It easy to perform taking a matter of seconds. It is totally safe and non-invasive, there is no harmful radiation.

25
Q

Differntials causing optic disc cupping/sectoral pallor of optic nerve

A
  • physiological disc cupping
  • congenital abnormalities of the optic nerve
  • retinal vascular occlusions
26
Q

Other causes of peripheral field loss

A
  • congenital abnormalities of the optic disc
  • retinal vascular occlusions
  • bitemporal hemianopia (optic chiasm compression)
  • retinitis pigmentosa
27
Q

What does glaucoma prognosis depend on?

A
  • age at onset
  • level of loss at diagnosis
  • starting IOP ( the higher the more treatment that may be needed)
  • type of glaucoma
  • response to treatment
  • ethnic origin
28
Q

What topical treatments improve drainage in glaucoma?

A

Prostaglandin analogues - iatanoprost
Symphamomimetics - brimonidine
Miotics - pilocarpine

29
Q

What topical treatments reduce aqeous production in glaucoma?

A

Beta blockers - timolol
Carbonic anhydras inhibitors - brinzolamide

30
Q

Laser options for glaucoma

A

Selective laser trabeculoplasty (SLT)

Argon lasertrabeculoplasty (ALT)

31
Q

What is optic disc cupping?

A

Thinning of the neuro-retinal rim

32
Q

Acute angle glaucoma symptoms

A

Acute painful red eye
Pain often severe ass w headache, nausea, vomitting
Impaired visual acuity and lights surrounded by haloes
Semi dilated and fixed pupil
Tender, hard eye - palpate v gently - raised IOP

33
Q

Precipitating factors acute angle glaucoma

A

Watch TV dark room
Semi-prone position
Use of adrenergic drug eg phenylephrine
Antimuscarinic drug eg tricyclic antidepressant

34
Q

What causes haloes?

A

hazy oedematous cornea

35
Q

Signs of chronic PAG

A

Increased IOP
Visual field defects
Cupped optic disc
Signs of angle closure on gonioscopy

36
Q

What glaucoma is a medical emergency?

A

Acute angle glaucoma

37
Q

1st line oral med for actue angle glaucoma

A

Acetazolamide 500mg
Antiemetic and anaglesia if required

38
Q

What IOP requires starting preventative treatment?

A

24mmHg
SLT - selective laser trabeculoplasty

ENT, neuro, eyes (34 decks)

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