Glaucoma Flashcards

1
Q

Glaucoma (2)

A

1) multifactorial disease
2) elevation of IOP incompatible with ocular health

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2
Q

Glaucoma pathogenesis (3)

A

1) reduced aqueous humor drainage capacity in ALL cases
2) results in progressive IOP elevation
3) irreversible vision loss through optic nerve & retinal ganglion cell death

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3
Q

Primary Glaucoma (2)

A

1) heritable, breed-related abnormality of aqueous drainage angle
2) rarely congenital

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4
Q

Secondary Glaucoma (1)

A

numerous causes of secondary drainage angle obstruction

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5
Q

Glaucoma clinical signs in acute disease (5)

A

1) blepharospasm
2) corneal edema
3) episcleral injection
4) dilated pupil
5) variable vision

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6
Q

Glaucoma clinical signs in chronic disease (5)

A

1) all acute signs possible
2) buphthalmos- swelling of eye
3) Haab’s striae- fracture/break in decimates membrane, streaks across cornea
4) lens subluxation- crescent appearance to lens
5) cupped optic nerve

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7
Q

Causes of canine primary glaucoma (4)

A

1) breed-related/hereditary condition
2) drainage angle abnormality
3) bilateral disease potential
4) one eye affected first then second weeks to months later

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8
Q

Causes of canine secondary glaucoma (6)

A

1) lens luxation
2) uveitis
3) hyphema
4) intraocular neoplasia
5) Melanocytic glaucoma
6) pigmentary uveitis
7) pseudophakia/aphakia
8) trauma

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9
Q

Feline glaucoma (4)

A

1) primary glaucoma is rare
2) secondary similar causes as dogs
3) uveitis common cause of secondary
4) aqueous humors misdirection (unique to cats)

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10
Q

Equine glaucoma (2)

A

1) primary glaucoma is rare
2) most cases secondary to equine recurrent uveitis (ERU)

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11
Q

Clinical findings in equine glaucoma (6)

A

1) usually an insidious disease
2) corneal edema (intermittent or persistent)
3) dilated pupil
4) Haab’s striae
5) lens luxation
6) vision loss

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12
Q

Glaucoma diagnosis (4)

A

1) clinical signs/findings
2) history/signalment
3) IOP measurement
4) Gonioscopy

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13
Q

Tonometry (5)

A

1) measurement of IOP
2) methods: rebound, applanation, indentation
3) 15-25 normal
4) abnormal: IOP differences between 2 eyes
5) important for assessing efficacy of glaucoma therapy

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14
Q

Gonioscopy (3)

A

1) examination of the drainage angle
2) requires specialized lens
3) helps determine likelihood of primary glaucoma based upon angle morphology

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15
Q

Goals of therapy (3)

A

1) maintenance of vision where possible
2) patient comfort in all cases
3) prophylaxis in “at risk” eyes

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16
Q

Emergency Management (2)

A

1) Systemic hyperosmotic medication
2) topical prostaglandin analogue

17
Q

Maintenance medication: Carbonic anhydrase inhibitors (CAIs) (4)

A

1) very effective
2) can be used in all species and all forms of glaucoma
3) topical and systemic formulation
4) Side effects: GI upset, panting, lethargy

18
Q

Maintenance medication: Miotics 7 prostaglandin analogues (topical) (3)

A

1) avoid in glaucoma secondary to uveitis or anterior lens luxation
2) reduce aqueous outflow
3) ocular side effects

19
Q

Maintenance medication: Beta blockers (topical) (2)

A

1) usually no adequate as sole agent
2) side effects

20
Q

Medical prophylaxis (1)

A

1) significantly delays onset of disease in second eye of dogs with primary glaucoma

21
Q

General treatment principles (6)

A

1) treat aggressively early in the course of disease
2) target IOP <20 mmHg
3) don’t taper medications in controlled cases
4) consider surgical intervention early in disease course
5) manage underlying disease
6) topical mydriatics are CONTRINDICATED (except horses)

22
Q

Surgical management: Decrease Aqueous production (1)

A

1) cyclodestructive procedures

23
Q

Surgical management: Increase Aqueous production (1)

A

1) filtering procedures/aqueous shunts

24
Q

Prognosis (2)

A

1) long term visual prognosis is poor
2) salvage surgical procedures- reduce pain

25
Q

Salvage procedures (3)

A

1) enucleation
2) evisceration/intrascleral prosthesis
3) chemical ciliary body ablation