Glaucoma

Question 1

What is glaucoma

Answer 1

Refers to the optic nerve damage - often from raised intraocular pressure

Question 2

Two types of gluacoma

Answer 2

Open angle and closed angle

Question 3

Causes of raised intraocular pressure

Answer 3

Blockage in aqueous humour

Question 4

Pathophysiology of open angle glaucoma

Answer 4

Gradual increase in resistance through the trabecular meshwork, so aqueous humour struggles to exit the eye

Question 5

Pathophysiology of acute angle-closure glaucoma

Answer 5

iris bulges forward and seals off the trabecular meshwork from the anterior chamber so pressure builds up quickly

Question 6

Risk factors for open angle glaucoma

Answer 6

Increasing age, family history, black ethnic origin, nearsightedness (myopia)

Question 7

Presentation of open angle glaucoma

Answer 7

Asymptomatic for a long time
Peripheral vision worsens (tunnel vision)
Gradual onset of fluctuating pain, headaches
Blurred vision
Halos around lights particularly at night

Question 8

What can you see on the optic disc from the increased pressure

Answer 8

Cupping

Question 9

How to measure intraocular pressure

Answer 9

Non-contact tonometry and Goldmann applanation tonometry

Question 10

Three investigations to diagnose open angle glaucoma

Answer 10

Goldmann aplanation tonometry, fundoscopy, visual field assessment

Question 11

Three results of investigations to diagnose open angle glaucoma

Answer 11

Raised intraocular pressure, optic disc cupping and optic nerve health, peripheral vision loss

Question 12

First line management of open angle glaucoma

Answer 12

Prostaglandin analogue eye drops

Question 13

What do prostaglandin analogues do

Answer 13

Increase uveoscleral outflow

Question 14

Options for management of open angle glaucoma which reduce aqueous production

Answer 14

Beta blocks
Carbonic anhydrase inhibitors
Sympathomimetics

Question 15

Eg of beta blockers

Answer 15

Timolol

Question 16

Eg of carbonic anhydrase inhibitors

Answer 16

Dorzolamide

Question 17

Eg of sympathomimetics

Answer 17

Brimonidine

Question 18

What is an option for open angle glaucoma if eye drops are ineffective

Answer 18

Trabeculectomy

Question 19

What is the intraocular pressure when treatment is started

Answer 19

24mmHg

Question 20

Risk factors for angle closure glaucoma

Answer 20

Increasing age, female (4x more), family history, chinease and east asian ethnicity, shallow anterior chamber

Question 21

Medications which can precipitate acute angle-closure glaucoma

Answer 21

Adrenergic medications - noradrenaline.
Anticholinergic medications - oxybutynin and solifenacin.
TCAs - amitriptyline

Question 22

Presentation of acute angle-closure glaucoma

Answer 22

Unwell
Severely painful eye
Blurred vision
Halos around lights
Associated headache, nausea and vomiting

Question 23

Examination findings of acute angle closure glaucoma

Answer 23

Red eye, teary
Hazy cornea
Decreased visual acuity
Dilatation of affected pupil, fixed pupil size
Firm eyeball on palpation

Question 24

Initial management of acute angle closure glaucoma

Answer 24

Lie patient on their back, give pilocarpine eye drops, give acetazolamide 500mg, give analgesia and antiemetic

Question 25

What does pilocarpine do to the eye

Answer 25

Acts on muscarinic receptors in the sphincter muscles in the iris causing constriction. Also causes ciliary muscle contraction

Question 26

Management of acute angle closure in secondary care

Answer 26

Pilocarpine, acetazolamide, hyperosmotic agents (mannitol, glycerol), timolol, dorzolamide, brimonidine