Glaucoma

Question 1

Types of glaucoma

Answer 1

• primary open angle glaucoma: chronic
• angle closure glaucoma: acute (irreversible vision loss in 48 to 72 hrs)

Question 2

RF of poag

Answer 2

• iop: >21mmHg
• age: elderly
• myopia
• fam hx of POAG
• vascular ds
• anti vegf therapy

Question 3

Fundoscopy

Answer 3

• optic cup to disc ratio > 0.7 (specific sign)
• bayonetting
• optic disc haemorrhage

Question 4

RF of acute angle closure glaucoma

Answer 4

• age (60 years old)
• gender ( female > male)
• family history
• hyperopia
• small eyeball

Question 5

Clinical presentation of acute angle closure glaucoma

Answer 5

• sudden onset of severe unilat eye pain/ frontal headache
• blurred vision
• rainbow coloured halos around bright light
• nausea
• vomiting
• increase IOP (60-80mmHg)
• red eye

Question 6

Fundoscopy of acute angle closure glaucoma

Answer 6

• dilated pupil
• hazy/cloudy cornea
• conjunctival injection
• shallow anterior chamber

Question 7

Clinical features and signs of chronic angle closure glaucoma

Answer 7

• asymptomatic in most pt
• visual disturbance (halos and reduction in vision)
• ocular discomfort

Signs
- increase IOP > 21mmHg
- peripheral anterior synechiae on gonioscopy

Question 8

Investigation done for glaucoma

Answer 8

• goldman applanation tonometer: to measure intraocular pressure
• gonioscopy: to differentiate between open angle and close angle glaucoma
• Humphrey visual field test: small paracentral depression, nasal step, arcuate defect, a ring scotoma

Question 9

Mx of glaucoma
- medical
- laser tx
- surgery

Answer 9

Medical
- prostaglandin analogue (1st line): latanoprost
- topical adrenergic b blocker: timolol
- carbonic anhydrase inhibitor: acetazolamide

Laser tx
- laser trabeculoplasty
- laser iridotomy (fastest)

Surgery
- trabeculectomy