glaucoma

Question 1

closed angled glaucoma (acute congestive glaucoma)/ angle-closure glaucoma pathophysiology and risk factors?

Answer 1

iris bows forward and obstructs drainage of aqueous -> sudden increase in IOP and optic nerve damage

risks: old age, shallow anterior chamber, family hx

Question 2

symptoms and signs of closed angle?

Answer 2

red eye, pain, blurry vision, photophobia with halo around lights
DILATED PUPIL (uveitis is CONSTRICTED)

decreased visual acuity
tonometry: high IOP (N: 9-21mHg)
genoiscope: narrow angle
shallow anterior chamber

Question 3

management and complication of acute closed angle?

Answer 3

can lead to irreversible vision loss

admit pt
medical tx first line drugs:
1. beta blocker (timolol) lowers production
2. prostaglandin analogs (latanoprost) increases drainage
3. carbonic anhydrase inhibitors (acetazolomide) decreases production

consider IV mannitol
surgical options:
1. laser iridotomy
2. surgical iridectomy
3. subscleral trabeculectomy

Question 4

open-angle glaucoma pathophysiology and risks?

Answer 4

pathophysiology: resistance to aqueous humor outflow through trabecular meshwork. causes GRADUAL vision loss

risks:
old age, african descent, family hx, DM, HTN, steroid use (increases IOP), high IOP, previous ocular trauma

Question 5

symptoms and signs of open-angle glaucoma?

Answer 5

PTS ARE COMMONLY ASYMPTOMATIC until vision loss becomes evident:

tunnel vision, arcuate scotoma, nasal step, paracentral defect

signs on fundoscopy
cupping (increased cup to disk ratio) >0.4
asymmetric C:D in both eyes
increased IOP may be found

Question 6

management of open-angle glaucoma?

Answer 6

medical tx: BB, CA inhibitors, prostaglandin analogs
trabeculectomy (bleb at site of injury)