Glaucoma

Question 1

Is an elevated eye pressure necessary to diagnose glaucoma?

Answer 1

No

Question 2

What is the main risk factor for glaucoma?

Answer 2

The level of the intraocular pressure

Question 3

What do we do to classify the glaucoma type?

Answer 3

Gonioscopy

Question 4

What determines the stage of the glaucoma?

Answer 4

The extent of damage to the optic nerve and visual field

Question 5

The most important intraocular pressure variable is the:

Answer 5

Amount of aqueous humor

Question 6

The pathology of elevated intraocular pressure is due to:

Answer 6

Inadequacies of aqueous outflow rather than production

Question 7

Gold standard for measuring intraocular pressure is:

Answer 7

Goldmann Applanation Tonometry (GAT)

Question 8

The aqueous humor is produced by:

Answer 8

The non-pigmented epithelium of the ciliary processes

Question 9

What is Primary Open Angle Glaucoma POAG?

Answer 9

Idiopathic increase in outflow resistance

Question 10

What are the causes of Secondary Open Angle Glaucoma SOAG?

Answer 10

1) Clogging of trabecular meshwork
2) Increased episcleral venous pressure (EVP)
3) Scarring of the trabecular meshwork
4) Increased trabecular meshwork resistance due to medications (steroids)

Question 11

What causes Increased episcleral venous pressure (EVP)?

Answer 11

1) Carotid cavernous fistula
2) Sturge Weber Syndrome
3) SVC obstruction

Question 12

What are some risk factors for Closed Angle Glaucoma?

Answer 12

1) Anatomic features predisposing to angle closure
2) Advanced age (>60 years)
3) Female gender
4) Inuit and Asian ethnicity
5) Eye injury with scarring and adhesions
6) Rubeosis iridis
7) Drugs: Sulfonamides, TCA, MAOi, antihistamines
8) Mydriasis

Question 13

Pathophysiology of Closed Angle Glaucoma?

Answer 13

Blocked trabecular meshwork → decreased drainage of aqueous humor from the eye → sudden ↑ in IOP

Question 14

Primary Closed Angle Glaucoma cause?

Answer 14

Chamber angle is narrowing due
to the peripheral iris obstructing the trabecular meshwork

Question 15

Complication of Acute Angle
Closure Attack?

Answer 15

Irreversible damage of the optic nerve

Question 16

Treatment of Acute Angle
Closure Attack?

Answer 16

1) Lower IOP:
a) Systemically: IV Acetazolamide/ Mannitol
oral Acetazolamide
b) Topical Eye drops: B blockers, α agonists, Carbonic
anhydrase inhibitors, pilocarpine

2) Break the angle closure cycle:
a) YAG laser Iridotomy/Surgical iridectomy

3) Examine second eye and treat prophylactically

Question 17

A thin cornea can give a falsely __(high/low) IOP reading, while a thick cornea can give falsely __(high/low) IOP

Answer 17

Low; High

Question 18

Signs of glaucoma?

Answer 18

1) Increased C:D
2) Thin rim
3) Notching
4) Hemorrhages
5) ISNT rule

Question 19

Optic nerve damage in glaucoma is ___(irreversible/reversible)

Answer 19

Irreversible

Question 20

Medical treatment for glaucoma?

Answer 20

1) Prostaglandin analogues (PGAs)
2) Beta Blockers
3) Alpha-2 agonists
4) Carbonic Anhydrase Inhibitors
5) Parasympathomimetic / Cholinergic agonists

Question 21

How do Prostaglandin analogues (PGAs) help in glaucoma?

Answer 21

Increases uveoscleral outflow

Question 22

One drawback of Prostaglandin analogues (PGAs)?

Answer 22

Proinflammation = hyperemia

Question 23

How do B-blockers help in glaucoma?

Answer 23

Decrease aqueous production

Question 24

Carbonic Anhydrase Inhibitors are contraindicated in which patinets?

Answer 24

Those with a sulfa allergy

Question 25

Laser treatments that increase outflow facility for glaucoma are:

Answer 25

1) Trabeculoplasty
2) Iridotomy

Question 26

Laser treatments that decrease aqueous production for glaucoma are:

Answer 26

Cyclodiode laser