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NBEO Part 2 > Glaucoma > Flashcards

Glaucoma Flashcards

1
Q

Treatment for Possner-Schlossman syndrome

A

IOP and inflammation control

IOP: treat with beta blockers, alpha-agonists or CAI
inflammation: topical steroid (pred acetate 1% QID)

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2
Q

RTC for Possner-Schlossman syndrome

A

1-2 days to check IOP

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3
Q

Symptoms of acute angle closure

A

Blurred vision
Ocular pain
Frontal headache
Nausea
Vomiting

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4
Q

Is acute angle closure unilateral or bilateral?

A

Unilateral

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5
Q

Acute angle closure glaucoma is frequently attributable to?

A

Pupillary block
Plateau iris

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6
Q

Signs of acute angle closure glaucoma (5)

A

Corneal edema
Conjunctival injection
Fixed and dilated pupil
Shallow anterior chamber
Significant elevated IOP

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7
Q

Best immediate treatment for acute angle closure glaucoma

A

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
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8
Q

How often should you check IOP for acute angle attack?

A

Every 15-30 minutes

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9
Q

Iridodonesis can be caused by?

A
  1. Trauma
  2. Weak zonules (because in PEX exfoliate material deposit on zonules and make them weak causing lens to move against iris
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10
Q

What is iridonesis?

A

Quivering iris
Vibration or agitated motion of iris with eye movements (caused from lens movement against iris from trauma or weak zonules)

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11
Q

A patient with PEX is going to get cataract surgery, what are they at higher risk of developing?

A

Dislocation of lens implant

  • psuedoexfoliative material is still produced which weakens the zonules more which can lead to dislocation
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12
Q

In patient with PDS, why can exercise exacerbate the condition?

A

Strenuous exercise can cause release of pigment which can block TM and lead to sudden rise in IOP

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13
Q

When evaluating pt with PDS, when should you check IOP?

A

Before AND after dilation
* especially when dilating with phenylephrine

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14
Q

PDS mostly occurs in which age group and gender?

A

Young myopic males with deep anterior chambers

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15
Q

What is Pigment Dispersion Syndrome (PDS)?

A

A condition generally occurring in young, myopic males with deep anterior chambers due to disruption of the posterior iris pigment epithelium.

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16
Q

What causes the release of pigment in PDS?

A

Disruption of the posterior iris pigment epithelium rubbing against the ciliary zonules.

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17
Q

What is the effect of convection currents in the anterior chamber?

A

Aqueous warms, rises, migrates forward, carries pigment granules, and then falls as it cools.

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18
Q

What is a Krukenberg spindle?

A

Pigment deposition on the corneal endothelium in a vertical, linear fashion.

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19
Q

What findings can be seen on gonioscopy in PDS patients?

A

Hyperpigmentation of the trabecular meshwork and Schwalbe’s line, as well as backward bowing of the iris.

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20
Q

Why is it important to monitor PDS patients?

A

To check for blockage of the trabecular meshwork, which can lead to increased intraocular pressure (IOP) and potential glaucomatous damage.

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21
Q

What is the inheritance pattern of PDS?

A

autosomal dominant

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22
Q

In which demographic is PDS more commonly observed?

A

Patients of Caucasian descent.

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23
Q

True or False: PDS is primarily a condition affecting older individuals.

A

False.
* white men 20-50 years old

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24
Q

Fill in the blank: The aqueous in the anterior chamber displays _______ currents.

A

convection

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25
Q

What can exacerbate release of iris pigment in PDS?

A

Strenuous physical exercise and pupil mydriasis

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26
Q

Which topical drug should be used with caution in PDS?

A

Phenylephrine
* adrenergic agonist= leads to pupil mydriais
* mydriasis can lead to more pigment release
* measure IOP pre and post-dilation

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27
Q

What is the likelihood that pt with PDS develops pigmentary glaucoma?

A

50%
* open angle glaucoma
* tx with topical prostaglandins
* LPI may also be beneficial

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28
Q

RTC for dx of PDS

A

6 months
* check IOP
* monitor if pt develops glaucoma, catch it early and manage to minimize damage to ON

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29
Q

Pt suffers from recurrent unilateral attacks of ocular hypertension presents with mild anterior chamber reaction with fine keratic precipitates.

A

Posner-Schlossman syndrome

  • aka glaucomatocyclitic crisis
  • linked to trabeculitis
  • open angle
  • self limiting condition that can last hours to weeks at a time
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30
Q

What is Posner-Schlossman Syndrome (PSS) also known as?

A

Glaucomatocyclitic crisis

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31
Q

What is the primary effect of Posner-Schlossman Syndrome on intraocular pressure (IOP)?

A

Acute rise in IOP lasting from hours to weeks
* IOP can reach up to 60 mmHg

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32
Q

In which age group is Posner-Schlossman Syndrome typically observed?

A

Young to middle-aged adults, more frequently in males

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33
Q

What are common symptoms of Posner-Schlossman Syndrome? (Glaucomatocyclitic crisis)

A
  • Blurred vision
  • Colored halos around light sources
  • Mild pain
  • Ocular redness

(Acute)
Unilateral
Mild, recurrent iritis with marked elevated IOP
Corneal edema
Fine keratic precipitates
Mid-dilated pupil
No synechiae
Self limiting

34
Q

What clinical sign is characterized by redness around the cornea in Posner-Schlossman Syndrome?

A

Ciliary flush

35
Q

What pupil condition may be observed in patients with Posner-Schlossman Syndrome?

A

A sluggish or dilated pupil

36
Q

What type of anterior chamber reaction is associated with Posner-Schlossman Syndrome?

A

Mild anterior chamber reaction
*keratic precipitates
* high IOP
*recurrent nature

37
Q

What condition of the cornea may occur in Posner-Schlossman Syndrome?

A

Corneal edema

38
Q

What will gonioscopy reveal in a patient with Posner-Schlossman Syndrome?

A

Open angles and absence of posterior synechiae

39
Q

What is the typical appearance of the optic nerves in Posner-Schlossman Syndrome?

A

Normal optic nerves

40
Q

What are the IOP readings typically observed in Posner-Schlossman Syndrome?

A

40-60 mmHg

41
Q

What is the primary treatment for Posner-Schlossman Syndrome?

A

Topical steroid drops and topical antiglaucoma medication

42
Q

Name three types of topical antiglaucoma medications used in the treatment of Posner-Schlossman Syndrome.

A
  • Alpha-agonist
  • Beta blocker
  • Carbonic anhydrase inhibitor
43
Q

RTC for posner-Schlossman syndrome

A

1-2 days check IOP
* if IOP still high adjust tx
* tx is topical steroids to manage inflammation and anti-glaucoma meds for IOP

44
Q

Hypotony

A

Abnormally low IOP
* below 6 mmHg

45
Q

What is blebitis?

A

An infection of a filtering bleb used to treat glaucoma.

46
Q

How soon after glaucoma surgery can a bleb become infected?

A

Within days to years after the surgery.

47
Q

What symptoms may patients with blebitis experience?

A

Painful red eye, mucous discharge, blurry vision, photophobia.

48
Q

What signs are indicative of blebitis?

A

White, inflamed bleb with anterior chamber reaction
* possibly hypopyon and vitritis.

49
Q

What is the initial treatment for blebitis?

A

Topical antibiotics Q1H.

50
Q

What should be used to treat the anterior chamber reaction in blebitis?

A

Topical cycloplegics.

51
Q

When should steroids be introduced in the treatment of blebitis?

A

After 24 hours.

52
Q

How often should patients with blebitis be followed up until the infection resolves?

53
Q

True or False: A patient with blebitis may require hospitalization.

54
Q

Fill in the blank: A filtering bleb used to treat glaucoma may become infected and symptoms may highly resemble _______.

A

Endophthalmitis.

55
Q

What is the gender ratio for primary angle-closure glaucoma (PACG)?

A

4:1 (females to males)

Females typically possess a shallower anterior chamber, contributing to this ratio.

56
Q

Which refractive error is associated with a higher likelihood of PACG?

A

Hyperopic refractive error

Patients with hyperopia are at increased risk for PACG.

57
Q

Which ethnic groups are more likely to suffer from PACG?

A

South-East Asian, Inuit, or Chinese descent

These populations show a higher prevalence of PACG.

58
Q

Which ethnic group is least likely to be affected by PACG?

A

African-Americans

This group has a lower incidence of PACG compared to others.

59
Q

What is the mean age of onset for PACG?

A

60 years

Risk for PACG increases with advanced age.

60
Q

What anatomical change contributes to increased risk of PACG with age?

A

Increase in the thickness of the crystalline lens

This change causes a decrease in anterior chamber depth.

61
Q

How does family history affect the risk of developing PACG?

A

Higher risk, especially with first-degree relatives

Inheritance of predisposing anatomical features is a factor.

62
Q

Fill in the blank: Patients with a _______ refractive error are more likely to suffer from PACG.

A

hyperopic

Hyperopia is associated with a greater risk for PACG.

63
Q

True or False: The risk of PACG decreases with advanced age.

A

False

The risk actually increases with age due to anatomical changes.

64
Q

Glaucomatous VF defects tend to present as?

A

Paracentral scotoma
* small and relatively steep depressions
* mostly observed in superior nasal to fovea
* damage to papillomacular bundle which will respect midline

Image shows left superior paracentral scotoma

65
Q

What is a characteristic finding in patients with glaucoma?

A

Damage to the optic nerve head resulting in a retinal nerve fiber bundle defect

This defect corresponds to a specific visual field defect.

66
Q

What do the earliest visual field changes in glaucoma suggest?

A

Increased variability of responses in an area that will eventually develop a defect

This variability is an early indicator of glaucomatous damage.

67
Q

How does a glaucomatous visual field defect typically present initially?

A

As a paracentral scotoma

Paracentral scotomas are small and steep depressions near the fovea.

68
Q

What percentage of early glaucomatous field defects can be characterized as paracentral scotomas?

A

Approximately 70%

This indicates the commonality of paracentral scotomas in early glaucoma.

69
Q

What is the cause of a paracentral scotoma in glaucoma?

A

Damage of the papillomacular bundle

This damage respects the horizontal midline.

70
Q

Can a single visual field test definitively prove a visual field defect exists?

A

No

Interpretation of visual fields should be done in conjunction with other clinical findings.

71
Q

What are Anderson’s criteria for determining glaucomatous damage?

A
  1. Glaucoma hemifield test outside normal limits on at least 2 consecutive occasions
  2. Cluster of 3 or more non-edge points depressed on PSD at P < 5% level, one at P < 1% level on 2 occasions
  3. CPSD occurring in less than 5% of normal individuals on two consecutive fields

These criteria help in the diagnosis and assessment of glaucoma.

72
Q

What is pigment dispersion syndrome (PDS)?

A

A condition that generally occurs in young, myopic males with deep anterior chambers.

73
Q

What causes pigment dispersion syndrome?

A

Disruption of the posterior iris pigment epithelium, causing it to rub against the ciliary zonules and release pigment.

74
Q

What happens to the aqueous in the anterior chamber during PDS?

A

It displays convection currents; warming inferiorly, it rises and migrates forward, carrying pigment granules.

75
Q

What is a Krukenberg spindle?

A

The vertical deposition of pigment on the corneal endothelium.

76
Q

What findings are observed during gonioscopy in PDS patients?

A

Hyperpigmentation of the trabecular meshwork and Schwalbe’s line, as well as backward bowing of the iris.

77
Q

What is the significance of monitoring PDS patients?

A

To check for blockage of the trabecular meshwork, which can cause a rise in intraocular pressure (IOP).

78
Q

What can a rise in intraocular pressure (IOP) in PDS lead to?

A

Potential glaucomatous damage to the optic nerve.

79
Q

What is the inheritance pattern of pigment dispersion syndrome?

A

Autosomal dominant trait with variable penetrance.

80
Q

In which population is PDS more commonly observed?

A

Patients of Caucasian descent.

81
Q

Fill in the blank: PDS generally occurs in young, myopic males with _______.

A

deep anterior chambers.

82
Q

True or False: PDS is primarily found in older females.

NBEO Part 2 (23 decks)

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