Glaucoma Flashcards
1
Q
Structures in angle of AC seen by gonios opy.
A
Outward to inward:
Schwalbe ‘s line
Trabecular meshwork
Scleral ring
Ciliary body band
2
Q
Portions of trabecular mesh work
A
Uveal portion
Corneoscleral
Juxtacanalicular mesh work -
Major proportion of normal resistance to aqueous outflow.
3
Q
Why is gonioscope used for seeing angle of anterior chamber ?
A
Critical angle of corneal air interface is 46 degrees.
Lead to total internal reflection.
4
Q
Openness of angle is measured by ….. at ….degrees
A
Van herick’s method.
60 degree.
5
Q
Types of gonioscopy
A
Direct : koeppe
Indirect:
Zeiss
Goldmann
Sussman
Possner
6
Q
Other uses of gonioscopy other than seeing the angle of anterior chamber. (4)
A
- To visualize any intraocular foreign body in the angles.
- Diagnose angle recession
- Evidence of neovascularization at the angle: PDR, CRVO
- In CRAO: do goniomassage.
7
Q
Acqeous humor is secreted by ……. by ……
A
Non pigmented ciliary epithelium
By active secretion. (90%)
Passive: ultrafiltration and diffusion
8
Q
Uveoscleral outflow is
Increased by ……
Decreased by ……
A
Prostaglandin analogues
Miotics
9
Q
Acqueous humor is ………(acidic/alkaline)
Ig present in aqueous humor
Increased acqueous humor LDH is seen in …..
A
Alkaline
IgG
Retinoblastoma
10
Q
In comparison to plasma, aqueous humor has …….levels (4)
A
Ascorbate 20times higher
Low glucose
Low protein
Hyperosmotic
11
Q
When compared to blood, …….has higher concentration of ascorbate
IOP normal range …..
Peaks in …..
A
Vitreous humor
11-21mmhg
Early morning
12
Q
Most accurate method for IOP
Variable force fixed area tonometers eg (3)
A
Mannometry
Goldmann
Perkins
Non-contact tonometer
13
Q
Non contact tononeters (3)
A
- Air puff tonometer
- Ocular response analyzer
- Corvis
14
Q
Pachymetry measures ……
Outflow of acqueous humor measured by …..
A
Corneal thickness
Tonography
(Tonometry measures IOP)
15
Q
Diaton tonometer is …….
Rebound tonometer is …..
Tonometer useful in post LASIK
A
Transpalpebral tonometer- can measure over the eyelid
Self tonometer
Dynamic contour tonometer : DCT/pascal
16
Q
Optic nerve derived from ……
Trabecular mesh work is pressure…..
Uveoscleral outflow is pressure …..
A
Optic stalk
Dependent
Independent
17
Q
Rapid change of glasses in:
Elderly
Young adult
A
- Glaucoma
- Keratoconus
18
Q
Advantages of diaton Tonometer (3)
A
- Keratoplasty - corneal transplant
- Corneal ulcer
- Tarsorraphy
19
Q
Dark room procedures (3)
A
- Slit lamp
- Gonioscopy
- Direct and indirect opthalmoscopy
20
Q
What is pentacam? (2)
A
Used for keratoconus
Preop evaluation of LASIK- to see the cornea.
21
Q
Define posner schlossman syndrome
A
Corneal epithelial edema-increased IOP.
Another name for angle closure glaucoma
Also called : glaucomatocyclitic crisis
22
Q
Causes of colored halos (7)
A
- Angle closure glaucoma-posner syndrome
- Corneal edema
- Acute mucopurulent conjunctivitis
- Senile immature cataract
- Acute anterior uveitis
- Epiphora
- Dirty contact lens usage
23
Q
Congenital glaucoma develops from …..
3 types of congenital glaucoma
A
Developmental anomaly of angle of anterior chamber.
True congenital glaucoma:
IOP rise in intrauterine life
Infantile glaucoma: birth-3 years
Juvenile glaucoma: 3-16 years
24
Q
Congenital glaucoma mc seen in …..
On chromosome…..
Most cases are …
A
Boys, b/l
Chromosome 2- AR
Sporadic
25
Pathology of congenital glaucoma (2)
Trabeculodysgenesis
Barkan’s membrane covering the angle of eye.
26
Normal corneal diameter is ……at ….months of age and …… at 1 year.
10mm, at 6 months of age.
12mm at 1 year
27
Differentiate between posner and fuch’s heterocyclitis
Posner: acute congestive angle closure glaucoma
Fuch’s : angle closure glaucoma + iris hypochromia + grey white nodules on anterior iris
28
Symptoms of congenital glaucoma (7)
1. Lacrimation
2. Photophobia
3. Blepharospasm
4. Hazy and large cornea
5. Corneal diameter >12mm
6. Buphalmos
7. Haab’s striae
29
Define haab’s striae
Progressive myopia of congenital glaucoma is due to ….(4)
Horizontal breaks in descements membrane.
1. Globe enlargement
2. Subluxated lens
3. Axial myopia
4. Optic disc cupping
30
Signs of congenital glaucoma (4)
1. IOP >21mmhg
2. Optic nerve cup:disc ratio=>0.3
3. Horizontal corneal diameter >12.5
4. Open angle with high iris insertion on gonioscopy.
31
IOP can be minimally reduced by: (3)
1. General anesthetics: halothane
2. Corneal edema
3. Overventilation
32
IOP may be falsely increased with …..(6)
1. Ketamine
2. Succinylcholine
3. Endotracheal intubation
4. Pressure from anethetic
5. Speculum use
6. Inadequate ventilation
33
2 genes causing primary open angle glaucoma
1. Myocilin- MYOC- on chrom 1q
aka- TIGR( trabecular meshwork induced glucocorticoid response protein.
2. Optineurin: chromosome 10p
34
Family history of POAG
Corticosteroid response of POAG
Sibling have greater chance than offspring
Significant increase in IOP.
35
IOP changes in POAG
1. Diurnal variation
2. IOP >5mmHg- suspicious of glaucoma
IOP> 8mmHg- dx of glaucoma
—-although the whole reading is still <21mmhg.
3. In late stage: IOP: >21mmhg
36
Splinter hemmorhage near disc margin aka….
Mc in……
Drance hge
Mc in normal tension glaucoma
37
RNFL defect seen in POAG is with ….
Advanced stages of POAG
Red free light-green filter
Bean pot cupping- total cupping with loss of bending of retinal vessels at margin of disc.
38
What is laminar sign?
Opening of lamina cribrosa visible upto margin of disc.
39
Earliest visual field defect in POAG
Earliest clinically significant field defect is..
Isopteric contraction
Isolated paracentral scotoma
40
Arcuate Scotsman is also called …..
What is nasal step?
Bjerrum scotoma
When 2 acruate scotoma meet each other at the horizontal meridian at sharp right angles to each other.
41
Double arcuate scotoma leads to ….
Last visual field to be lost in POAG
Tubular vision
Temporal island of visual field- with no perception of light.
42
Stimulus size of…..is used in Humphrey visual field
RNFL is analyzed by ….(3)
3 MC (4mm2)
OCT
VCC
HRT
43
RNFL analysis is done to detect …..
Central/centrocecal scotoma is dx of …..(2)
Preperimetric glaucoma
ONH
Macular d/o
44
Water drinking provocative test is used for ….
Other tests are…(4)
POAG
1. Jugular vein compression
2. Bulbar pressure test
3. Priscol test
4. Caffeine test
45
DDLS is ……
Laser trabeculoplasty is useful in ….(3)
Disc Damage Likelihood scale
POAG
Pseudoexfoliation glaucoma
Pigmentary glaucoma
46
Laser trabeculoplasty not useful in…..(2)
Angle closure glaucoma
Uveitic glaucoma
47
2 types of trabeculoplasty adv /disadv of them
Argon laser: cause scarring of TM
not repeatable
Selective laser trabeculoplasty:
Uses 532mn freq doubled Nd YAG
No scarring of TM, Repeatable
48
Antimetabolites are used in trabeculectomy to minimize scarring but they form blebs.
What are the indications of anti metabolite? (5)
1. Younger patients
2. African Black race
3. Neovascular/ I.F glaucoma
4. Combined surgery
5. Previously failed trabeculectomy
49
Artificial implants eg (3)
Molteno
Baerveldt
Ahmed glaucoma valve
50
Egs of MIGS (3)
Express shunt
Canaloplasty
Trabectome
51
Cause of normal tension glaucoma
Chronic low vascular perfusion-hypotension, CVS disease that makes the optic nerve head susceptible to damage by normal IOP.
52
NTG mc in …..
Visual field defects are…..
Optic nerve head is ….
Japan
Denser and closer to fixation
Larger
53
Association more commonly seen in NTG than POAG (6)
1. Raymaud’s phenomenon
2. Nocturnal systemic hypotension
3. Over rx for systemic HTN
4. Reduced blood flow to opthalmic artery.
5. Paraproteinemia
6. Presence of serum autoantibodies
54
Beta blocker used for asthma patients
Metipranolol causes …
Betaxolol- cardioselective
Granulomatous uveitis
55
S/e of miotics
MY EYE
Head and brow pain
Retinal detachment
Nasolacrimal obstruction
Myopia
Iris cyst
Lens cataract
56
S/e of beta blocker (3)
BDS
Blepharoconjunctivitis
Dry eye
Superior punctuate keratitis
57
S/e of PG analogue
E FGHI
E-cystoid macular edema
PDF2
Hypertrichiasis
Iris pigment.
58
What is dipevefrine?
Analogue of epinephrine
Alpha 2 agonist
S/e: black pigmentation of conjunctiva
59
Appearance of cystitis macular edema
Smoke stack appearance
Flower petal
Central serous retinopathy
60
S/e of apraclonidine (2)
Lid retraction
Follicular conjunctivitis
61
C/I of carbonic anhydride inhibitors
C/I sulfa allergy
Keratoplasty/ corneal d/o
62
Eg of rho kinase inhibitor
Ripasudil
Netarsudil
63
MOA of Rho kinase inhibitor
S/e
Increases aqueous outflow through direct action of trabecular mesh work and schlemm canal.
Conjunctival hge
Conjunctival hyperemia
64
Ripasudil s/e (2)
Corneal endothelial dysfunction
in fusch’s endothelial dystrophy
Post cataract surgery corneal damage
65
DOC for glaucoma in pregnancy
Brimonidine
66
Hyperosmotic used in diabetics (2(
Mannitol
Isosorbide
67
MOA of PACG
Features of latent glaucoma (prodomal phase)
Pupillary block mechanism
1. Transient IOP- 40-60mmhg
2. Colored haloes
68
Intermittent glaucoma stage of PACG
Haloes seen in PACG is ….
Predisposed eye with occluded angle. -mysriasis in dark room
Blue-violet innermost
69
Define Vogt’s triad
1. Glaucomafleckon- anterior subcapsular lens opacity.
2. Iris atrophy
3. Slightly Dilated non reactive pupil- sphincter atrophy.
70
Double hump sign and sine wave sign on gonaioscopy seen with ….
Plateau iris
71
What is phacolytic glaucoma ?
Seeen in hyper mature cataract
Leakage of lens protein through microscopic defects in intact capsule
Macrophages block the TM and occlude blood flow.
72
Deep anterior chamber seen in ….
Rx for phacolytic glaucoma
Phacolytic glaucoma -open angles
Decrease IOP
Cataract extraction
Thorough AC wash
73
What is lens particle glaucoma ?
Rx (3)
Disruption of lens capsule during cataract extraction or penetrating injury—free particulate lens material released and obstruct TM
Rx:
1. Lower IOP
2. irrigation aspiration of lens matter in AC
3. Vitrectomy- if associated with posterior capsule rupture
74
What is phacomorphic glaucoma? (5).
Rx.
Ass with intumescant cataract
High IOP
Shallow AC
Corneal edema
Pain
Extraction of cataract after lowering IOP
75
Phacoanaphylactic glaucoma seen in….
Autoimmune granulomatous reaction to lens protein- from previous cataract sx or penetrating injury.
76
What is phacotropic glaucoma?
Dislocation of lens into AC-blocking angle and giving rise to secondary angle closure glaucoma.
77
Define neovascular glaucoma
CRVO is aka…..
Neovascularisation of iris and angle of AC-rubeosis iridis.
90 day glaucoma
78
Causes of neovascular glaucoma (7)
1. DR
2. Ischemic CRVO
3. Sickle cell retinopathy
4. ROP
5. Long standing intraocular tumor
6. CRAO
7. Carotid obstructive disease
79
Rx for neovascular glaucoma
Panretinal photocoagulation + intravitreal avastin ( bevacizumab)
IOP uncontrolled:
Trabeculectomy + antimetabolites/
Artificial valve.
80
…….glaucoma came seen following traveculectomy/ any intra operative sx.
Features (3)
Ciliary block- malignant glaucoma.
1. Flat AC
2. Negative Seidel test-no wound leak
3. Markedly raised IOP
81
Mechanism of ciliary block glaucoma
Ciliolenticular block/ ciliovitreal block—acqueous misdirection syndrome
82
Only glaucoma Rx with atropine is ….
Sx done is ….
Ciliary block-malignant glaucoma
Mydriatics: phenylephrine + atropine1%
Posterior sclerotomy
83
Posner syndrome is aka
Seen with ……
Associated with …..
Glaucomatocyclitic crisis
U/L disease of young adults
HLABW54
84
Sms of posner syndrome
1. Recurrent attacks of acute secondary ACG
2. Mild anterior uveitis -HTN uveitis
3. Raised IOP- due to acute trabeculitis
85
Signs of posner syndrome (4)
1. White eye- minimally congested
2. Corneal epithelial edema- colored haloes
3. Fine white central keratin ppt
4. IOP is very high
86
3 ICE syndromes
Iridocorneal endothelial syndrome
1. Progressive iris atrophy—>
Corectopia- distortion of pupil
Polycoria- multiple pupils
2. Chandler syndrome—> corneal edema
3. Cogan reese syndrome—>
Nodular/diffuse pigmented lesion
87
ICE syndrome affects …..
Mx feature of ICE syndrome
One eye of young to middle aged women
Hammered silver appearance-corneal cells that proliferate to form endothelial membrane.
88
Rx of ICE syndrome
Trabeculectomy + antimetabolites /
Glaucoma valve
89
Final stage of any glaucoma is …..
C/f
Complications of the above (3)
Absolute glaucoma
Painful, irritable, extremely high stony hard eye
Corneal ulceration
Staphyloma formation
Atrophic bulbi
90
Rx for absolute glaucoma (3)
Cyclocryotherapy
Transacleral diode laser photocoagulation
Endoscopic cyclophotocoagulatiom
91
What is pseudoexfoliation glaucoma ?
Pigment along scalbe’s line is called ….
Complication
Whitish powdery material at pupillary margin and on lens surface(3 ring sign)
Sampaolesi line
Zonular dehiscence
Vitreous loss during cataract surgery
92
Glaucoma that may be seen with young myopic males
Rx.
Pigment glaucoma- pigment on corneal endothelium. -krukenberg spindle.
Hyperpigmented open angle.
YAG laser PI to reverse pupillary block
93
Angle recession glaucoma is seen after …..
Gonisoscopy featires
Blunt trauma to eye
Irregular widening of ciliary body band on gonioscopy
94
Very high IOP with colored haloes s/o
What is UGH syndrome? Ass with ….
Epidemic dropsy—> hypersecretion glaucoma
Uveitis
Glaucoma
Hyphema
Anterior chamber lens implantation
95
Ghost glaucoma occurs with …..
How this happens?
Aphakic eyes with vitreous hge
After 2 weeks of vitrous hge, RBC lose their pliability and become khaki colored-ghost cells-pass from vitreous cavity —-> AC and block trabeculae leading to rise in IOP.
96
What are ghost glaucoma?
Aphakic eyes with vitreous hge.
After 2 weeks of hge, RBC lose their pliability and become khaki colored. Then pass from vitreous to AC and block trabecular meshwork -> increase in IOP.
97
Glaucoma due to increased episcleral venous pressure seen in ….
Sturge weber syndrome -carotico cavernous fistula
