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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

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 what demographic?

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 are the genetic characteristics of PDS?

A

It has gene loci on chromosomes 7 and 8, with an autosomal dominant trait and variable penetrance.

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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

24
Q

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

A

convection

25
Q

What can exacerbate release of iris pigment in PDS?

A

Strenuous physical exercise and pupil mydriasis

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 post-dilation

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

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

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
  • self limiting condition that can last hours to weeks at a time
30
Q

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

A

Glaucomatocyclitic crisis

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

32
Q

In which demographic is Posner-Schlossman Syndrome typically observed?

A

Young to middle-aged adults, more frequently in males

33
Q

What are common symptoms of Posner-Schlossman Syndrome?

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

37
Q

What ocular feature may be present in Posner-Schlossman Syndrome?

A

Keratic precipitates

38
Q

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

A

Corneal edema

39
Q

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

A

Open angles and absence of posterior synechiae

40
Q

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

A

Normal optic nerves

41
Q

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

A

40-60 mmHg

42
Q

What is the primary treatment for Posner-Schlossman Syndrome?

A

Topical steroid drops and topical antiglaucoma medication

43
Q

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

A
  • Beta blocker
  • Alpha-agonist
  • Carbonic anhydrase inhibitor
44
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

45
Q

Hypotony

A

Abnormally low IOP
* below 6 mmHg

46
Q

What is blebitis?

A

An infection of a filtering bleb used to treat glaucoma.

47
Q

How soon after glaucoma surgery can a bleb become infected?

A

Within days to years after the surgery.

48
Q

What symptoms may patients with blebitis experience?

A

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

49
Q

What signs are indicative of blebitis?

A

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

50
Q

What is the initial treatment for blebitis?

A

Topical antibiotics Q1H.

51
Q

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

A

Topical cycloplegics.

52
Q

When should steroids be introduced in the treatment of blebitis?

A

After 24 hours.

53
Q

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

A

Daily.

54
Q

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

A

True.

55
Q

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

A

Endophthalmitis.

NBEO Part 2 (20 decks)

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