Glaucoma Flashcards
Treatment for Possner-Schlossman syndrome
IOP and inflammation control
IOP: treat with beta blockers, alpha-agonists or CAI
inflammation: topical steroid (pred acetate 1% QID)
RTC for Possner-Schlossman syndrome
1-2 days to check IOP
Symptoms of acute angle closure
Blurred vision
Ocular pain
Frontal headache
Nausea
Vomiting
Is acute angle closure unilateral or bilateral?
Unilateral
Acute angle closure glaucoma is frequently attributable to?
Pupillary block
Plateau iris
Signs of acute angle closure glaucoma (5)
Corneal edema
Conjunctival injection
Fixed and dilated pupil
Shallow anterior chamber
Significant elevated IOP
Best immediate treatment for acute angle closure glaucoma
1 drop timolol 0.5% (beta blocker)
1 drop pilocarpine 2% (direct cholinergic)
1 drop apraclonidine 1% (alpha agonist)
And oral acetazolamine 500 mg by mouth (CAI)
- measure IOP every 15-30 minutes
How often should you check IOP for acute angle attack?
Every 15-30 minutes
Iridodonesis can be caused by?
- Trauma
- Weak zonules (because in PEX exfoliate material deposit on zonules and make them weak causing lens to move against iris
What is iridonesis?
Quivering iris
Vibration or agitated motion of iris with eye movements (caused from lens movement against iris from trauma or weak zonules)
A patient with PEX is going to get cataract surgery, what are they at higher risk of developing?
Dislocation of lens implant
- psuedoexfoliative material is still produced which weakens the zonules more which can lead to dislocation
In patient with PDS, why can exercise exacerbate the condition?
Strenuous exercise can cause release of pigment which can block TM and lead to sudden rise in IOP
When evaluating pt with PDS, when should you check IOP?
Before AND after dilation
* especially when dilating with phenylephrine
PDS mostly occurs in what demographic?
Young myopic males with deep anterior chambers
What is Pigment Dispersion Syndrome (PDS)?
A condition generally occurring in young, myopic males with deep anterior chambers due to disruption of the posterior iris pigment epithelium.
What causes the release of pigment in PDS?
Disruption of the posterior iris pigment epithelium rubbing against the ciliary zonules.
What is the effect of convection currents in the anterior chamber?
Aqueous warms, rises, migrates forward, carries pigment granules, and then falls as it cools.
What is a Krukenberg spindle?
Pigment deposition on the corneal endothelium in a vertical, linear fashion.
What findings can be seen on gonioscopy in PDS patients?
Hyperpigmentation of the trabecular meshwork and Schwalbe’s line, as well as backward bowing of the iris.
Why is it important to monitor PDS patients?
To check for blockage of the trabecular meshwork, which can lead to increased intraocular pressure (IOP) and potential glaucomatous damage.
What are the genetic characteristics of PDS?
It has gene loci on chromosomes 7 and 8, with an autosomal dominant trait and variable penetrance.
In which demographic is PDS more commonly observed?
Patients of Caucasian descent.
True or False: PDS is primarily a condition affecting older individuals.
False.
* white men 20-50 years old
Fill in the blank: The aqueous in the anterior chamber displays _______ currents.
convection
What can exacerbate release of iris pigment in PDS?
Strenuous physical exercise and pupil mydriasis
Which topical drug should be used with caution in PDS?
Phenylephrine
* adrenergic agonist= leads to pupil mydriais
* mydriasis can lead to more pigment release
* measure IOP post-dilation
What is the likelihood that pt with PDS develops pigmentary glaucoma?
50%
* open angle glaucoma
* tx with topical prostaglandins
* LPI may also be beneficial
RTC for dx of PDS
6 months
* check IOP
* monitor if pt develops glaucoma, catch it early and manage to minimize damage to ON
Pt suffers from recurrent unilateral attacks of ocular hypertension presents with mild anterior chamber reaction with fine keratic precipitates.
Posner-Schlossman syndrome
- aka glaucomatocyclitic crisis
- self limiting condition that can last hours to weeks at a time
What is Posner-Schlossman Syndrome (PSS) also known as?
Glaucomatocyclitic crisis
What is the primary effect of Posner-Schlossman Syndrome on intraocular pressure (IOP)?
Acute rise in IOP lasting from hours to weeks
* IOP can reach up to 60 mmHg
In which demographic is Posner-Schlossman Syndrome typically observed?
Young to middle-aged adults, more frequently in males
What are common symptoms of Posner-Schlossman Syndrome?
- Blurred vision
- Colored halos around light sources
- Mild pain
- Ocular redness
What clinical sign is characterized by redness around the cornea in Posner-Schlossman Syndrome?
Ciliary flush
What pupil condition may be observed in patients with Posner-Schlossman Syndrome?
A sluggish or dilated pupil
What type of anterior chamber reaction is associated with Posner-Schlossman Syndrome?
Mild anterior chamber reaction
What ocular feature may be present in Posner-Schlossman Syndrome?
Keratic precipitates
What condition of the cornea may occur in Posner-Schlossman Syndrome?
Corneal edema
What will gonioscopy reveal in a patient with Posner-Schlossman Syndrome?
Open angles and absence of posterior synechiae
What is the typical appearance of the optic nerves in Posner-Schlossman Syndrome?
Normal optic nerves
What are the IOP readings typically observed in Posner-Schlossman Syndrome?
40-60 mmHg
What is the primary treatment for Posner-Schlossman Syndrome?
Topical steroid drops and topical antiglaucoma medication
Name three types of topical antiglaucoma medications used in the treatment of Posner-Schlossman Syndrome.
- Beta blocker
- Alpha-agonist
- Carbonic anhydrase inhibitor
RTC for posner-Schlossman syndrome
1-2 days check IOP
* if IOP still high adjust tx
* tx is topical steroids to manage inflammation and anti-glaucoma meds for IOP
Hypotony
Abnormally low IOP
* below 6 mmHg
What is blebitis?
An infection of a filtering bleb used to treat glaucoma.
How soon after glaucoma surgery can a bleb become infected?
Within days to years after the surgery.
What symptoms may patients with blebitis experience?
Painful red eye, mucous discharge, blurry vision, photophobia.
What signs are indicative of blebitis?
White, inflamed bleb with anterior chamber reaction, possibly hypopyon and vitritis.
What is the initial treatment for blebitis?
Topical antibiotics Q1H.
What should be used to treat the anterior chamber reaction in blebitis?
Topical cycloplegics.
When should steroids be introduced in the treatment of blebitis?
After 24 hours.
How often should patients with blebitis be followed up until the infection resolves?
Daily.
True or False: A patient with blebitis may require hospitalization.
True.
Fill in the blank: A filtering bleb used to treat glaucoma may become infected and symptoms may highly resemble _______.
Endophthalmitis.
