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SA dx/tx > Glaucoma > Flashcards

Glaucoma Flashcards

1
Q

What is the aqueous humor flow?

A

Ciliary body > posterior chamber > pupil > anterior chamber > iridocorneal angle > venous drainage

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2
Q

What is glaucoma almost always due to?

A

Impaired outflow

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3
Q

Where do the majority of species outflow aqueous humor?

A

Iridocorneal angle

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4
Q

What are the acute clinical signs of glaucoma?

A

Episcleral injection
Blepharospasm
Corneal edema
Mydriasis
Impaired vision

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5
Q

What are the chronic clinical signs of glaucoma?

A

Optic disc cupping
Retinal degeneration
Irreversible blindness
Buphthalmos (larger stretched out globe - haab’s stria (stretch marks))
Phthisis bulbi (shrinking of the eye - super end stage)
Lens subluxation

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6
Q

What does a buphthalmic globe indicate? Execept in?

A

Blindness
Except in puppies and shar peis

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7
Q

What is the IOP difference between buphthalmia and exophthalmia?

A

Often markedly elevated with buphthalmia
Normal or mildly elevated with exophthalmia

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8
Q

What is the corneal diameter difference between buphthalmia and exophthalmia?

A

Larger with buphthalmia
Normal with exophthalmia

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9
Q

What is the lens luxation difference between buphthalmia and exophthalmia?

A

Secondary subluxation with buphthalmia
Normal with exophthalmia

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10
Q

What is the vision difference between buphthalmia and exophthalmia?

A

Blind with buphthalmia
Usually visual with exophthalmia

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11
Q

What is a normal IOP?

A

12-24 mmHg

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12
Q

When should you check the IOP?

A

With every red eye (episcleral injection) with an intact cornea

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13
Q

What is the most accurate IOP?

A

The lowest

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14
Q

What is a main issue with tonopens?

A

Reduced accuracy at higher IOP especially with cats
Significantly underestimates IOP

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15
Q

How does applanation tonometry work?

A

Correlates force to flatten cornea with IOP
Local anesthetic is recommended

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16
Q

How does rebound tonometry work?

A

Correlates speed of bounce off cornea to IOP
No topical anesthetic is needed

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17
Q

How does rebound tonometry work?

A

Correlates speed of bounce off cornea to IOP
No topical anesthetic is needed
More accurate

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18
Q

What is the most common primary glaucoma in dogs?

A

Primary angle closure glaucoma

19
Q

What breeds are predisposed to primary angle closure glaucoma?

A

Cocker spaniels and basset hounds

20
Q

What type of glaucoma are beagles predisposed to?

A

Primary open angle glaucoma

21
Q

What is secondary glaucoma associated with?

A

Other ocular or systemic abnormalities

22
Q

What are the three most common causes of secondary glaucoma?

A

Uveitis - most common
Neoplasia
Lens luxation

23
Q

What is the pathogenesis of primary angle closure glaucoma?

A

Development of iridocorneal angle arrested
Aqueous production does not = aqueous outflow
Aqueous outflow decreases so IOP increases
Diagnosis of exclusion

24
Q

What is gonioscopy used for?

A

Examine the iridocorneal angle
Referral procedure
Subjective

25
Q

What is the common signalment of primary angle closure glaucoma?

A

Female
Middle-aged to older dog
Cocker spaniel or basset hound
Glaucoma develops in other eye ~ 8 months later

26
Q

What should you prepare patients for with a glaucoma patient?

A

A blind dog
We almost always eventually fail to preserve vision and are often considering comfort

27
Q

What is the most effective canine therapy for primary glaucoma?

A

Latanoprost 0.0005%
Topical prostaglandin derivative (mimics uveitis)
Increases uveoscleral outflow
Potent mitotic

28
Q

When are prostaglandin derivatives contraindicated?

A

Secondary glaucoma due to severe uveitis
Anterior lens luxation
Not effective in most forms of feline glaucoma

29
Q

What should you use for secondary glaucoma in dogs and glaucoma in cats and horses?

A

Dorzolamide 2% / Timolol
Decreases aqueous production
Does not affect pupil size
Carbonic anhydrase inhibitor
Given between drops of Latanoprost

30
Q

What can be used for inflammation control topically?

A

Neo/poly/dex 0.1%
Prednisolone acetate 1%

31
Q

What can be used if topical medication is ineffective?

A

IV mannitol 20%
Hyperosmotic
Dehydrates vitreous

32
Q

What are the contraindications when using Mannitol?

A

Heart disease
DM
Renal failure
Uveitis

33
Q

What is the prognosis for medical management of glaucoma?

A

Medical therapy will often fail within 6 months
Glaucoma is progressive and does not go away

34
Q

What surgical therapy can be done to increase outflow?

A

Gonioimplants
Tube inside anterior chamber
Gives you about 6 months of control of IOP before failure due to fibrosis

35
Q

What surgical therapy can be done to decrease production of aqueous humor?

A

Destruction of the ciliary body
Cyclophotocoagulation - diode laser
Laser is dependent on pigment so it is not consistent

36
Q

What are the complications of using a diode laser?

A

Postoperative pressure spike
Cataract formation
Inflammation

37
Q

What should be done for the other healthy eye?

A

Prophylactic therapy
Dorzolamide/Timolol
Demarcarium bromide
Latanoprost
Recheck every 1-3 months

38
Q

What are the three treatment options for end stage glaucoma?

A

Enucleation
Intrascleral prosthesis (remove inner contents of globe and place silicone ball)
Chemical ciliary body ablation (intravitreal gentamicin or cidofovir)

39
Q

What are the contraindications for intrascleral prosthesis and chemical ciliary body ablation?

A

Corneal disease
Uveitis
Tumor

40
Q

What is feline glaucoma usually due to?

A

Uveitis

41
Q

What is the most common complaint of feline glaucoma?

A

Mydriasis

42
Q

What procedure is contraindicated in cats?

A

Chemical ciliary body ablation
Can lead to aggressive tumor formation

43
Q

What is the only salvage procedure available for cats?

A

Enucleation
Do not put a prothesis - they like to reject them

SA dx/tx (26 decks)

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