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NBEO Part 2 > Glaucoma > Flashcards

Glaucoma Flashcards

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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
What can exacerbate release of iris pigment in PDS?
Strenuous physical exercise and pupil mydriasis
26
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 pre and post-dilation
27
What is the likelihood that pt with PDS develops pigmentary glaucoma?
50% * open angle glaucoma * tx with topical prostaglandins * LPI may also be beneficial
28
RTC for dx of PDS
6 months * check IOP * monitor if pt develops glaucoma, catch it early and manage to minimize damage to ON
29
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 * linked to trabeculitis * open angle * self limiting condition that can last hours to weeks at a time
30
What is Posner-Schlossman Syndrome (PSS) also known as?
Glaucomatocyclitic crisis
31
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
32
In which age group is Posner-Schlossman Syndrome typically observed?
Young to middle-aged adults, more frequently in males
33
What are common symptoms of Posner-Schlossman Syndrome? (Glaucomatocyclitic crisis)
* 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
What clinical sign is characterized by redness around the cornea in Posner-Schlossman Syndrome?
Ciliary flush
35
What pupil condition may be observed in patients with Posner-Schlossman Syndrome?
A sluggish or dilated pupil
36
What type of anterior chamber reaction is associated with Posner-Schlossman Syndrome?
Mild anterior chamber reaction *keratic precipitates * high IOP *recurrent nature
37
What condition of the cornea may occur in Posner-Schlossman Syndrome?
Corneal edema
38
What will gonioscopy reveal in a patient with Posner-Schlossman Syndrome?
Open angles and absence of posterior synechiae
39
What is the typical appearance of the optic nerves in Posner-Schlossman Syndrome?
Normal optic nerves
40
What are the IOP readings typically observed in Posner-Schlossman Syndrome?
40-60 mmHg
41
What is the primary treatment for Posner-Schlossman Syndrome?
Topical steroid drops and topical antiglaucoma medication
42
Name three types of topical antiglaucoma medications used in the treatment of Posner-Schlossman Syndrome.
* Alpha-agonist * Beta blocker * Carbonic anhydrase inhibitor
43
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
44
Hypotony
Abnormally low IOP * below 6 mmHg
45
What is blebitis?
An infection of a filtering bleb used to treat glaucoma.
46
How soon after glaucoma surgery can a bleb become infected?
Within days to years after the surgery.
47
What symptoms may patients with blebitis experience?
Painful red eye, mucous discharge, blurry vision, photophobia.
48
What signs are indicative of blebitis?
White, inflamed bleb with anterior chamber reaction * possibly hypopyon and vitritis.
49
What is the initial treatment for blebitis?
Topical antibiotics Q1H.
50
What should be used to treat the anterior chamber reaction in blebitis?
Topical cycloplegics.
51
When should steroids be introduced in the treatment of blebitis?
After 24 hours.
52
How often should patients with blebitis be followed up until the infection resolves?
Daily.
53
True or False: A patient with blebitis may require hospitalization.
True.
54
Fill in the blank: A filtering bleb used to treat glaucoma may become infected and symptoms may highly resemble _______.
Endophthalmitis.
55
What is the gender ratio for primary angle-closure glaucoma (PACG)?
4:1 (females to males) ## Footnote Females typically possess a shallower anterior chamber, contributing to this ratio.
56
Which refractive error is associated with a higher likelihood of PACG?
Hyperopic refractive error ## Footnote Patients with hyperopia are at increased risk for PACG.
57
Which ethnic groups are more likely to suffer from PACG?
South-East Asian, Inuit, or Chinese descent ## Footnote These populations show a higher prevalence of PACG.
58
Which ethnic group is least likely to be affected by PACG?
African-Americans ## Footnote This group has a lower incidence of PACG compared to others.
59
What is the mean age of onset for PACG?
60 years ## Footnote Risk for PACG increases with advanced age.
60
What anatomical change contributes to increased risk of PACG with age?
Increase in the thickness of the crystalline lens ## Footnote This change causes a decrease in anterior chamber depth.
61
How does family history affect the risk of developing PACG?
Higher risk, especially with first-degree relatives ## Footnote Inheritance of predisposing anatomical features is a factor.
62
Fill in the blank: Patients with a _______ refractive error are more likely to suffer from PACG.
hyperopic ## Footnote Hyperopia is associated with a greater risk for PACG.
63
True or False: The risk of PACG decreases with advanced age.
False ## Footnote The risk actually increases with age due to anatomical changes.
64
Glaucomatous VF defects tend to present as?
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
What is a characteristic finding in patients with glaucoma?
Damage to the optic nerve head resulting in a retinal nerve fiber bundle defect ## Footnote This defect corresponds to a specific visual field defect.
66
What do the earliest visual field changes in glaucoma suggest?
Increased variability of responses in an area that will eventually develop a defect ## Footnote This variability is an early indicator of glaucomatous damage.
67
How does a glaucomatous visual field defect typically present initially?
As a paracentral scotoma ## Footnote Paracentral scotomas are small and steep depressions near the fovea.
68
What percentage of early glaucomatous field defects can be characterized as paracentral scotomas?
Approximately 70% ## Footnote This indicates the commonality of paracentral scotomas in early glaucoma.
69
What is the cause of a paracentral scotoma in glaucoma?
Damage of the papillomacular bundle ## Footnote This damage respects the horizontal midline.
70
Can a single visual field test definitively prove a visual field defect exists?
No ## Footnote Interpretation of visual fields should be done in conjunction with other clinical findings.
71
What are Anderson's criteria for determining glaucomatous damage?
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 ## Footnote These criteria help in the diagnosis and assessment of glaucoma.
72
What is pigment dispersion syndrome (PDS)?
A condition that generally occurs in young, myopic males with deep anterior chambers.
73
What causes pigment dispersion syndrome?
Disruption of the posterior iris pigment epithelium, causing it to rub against the ciliary zonules and release pigment.
74
What happens to the aqueous in the anterior chamber during PDS?
It displays convection currents; warming inferiorly, it rises and migrates forward, carrying pigment granules.
75
What is a Krukenberg spindle?
The vertical deposition of pigment on the corneal endothelium.
76
What findings are observed during gonioscopy in PDS patients?
Hyperpigmentation of the trabecular meshwork and Schwalbe's line, as well as backward bowing of the iris.
77
What is the significance of monitoring PDS patients?
To check for blockage of the trabecular meshwork, which can cause a rise in intraocular pressure (IOP).
78
What can a rise in intraocular pressure (IOP) in PDS lead to?
Potential glaucomatous damage to the optic nerve.
79
What is the inheritance pattern of pigment dispersion syndrome?
Autosomal dominant trait with variable penetrance.
80
In which population is PDS more commonly observed?
Patients of Caucasian descent.
81
Fill in the blank: PDS generally occurs in young, myopic males with _______.
deep anterior chambers.
82
True or False: PDS is primarily found in older females.
False.

NBEO Part 2 (23 decks)

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