Glaucoma Flashcards
def. of glaucoma
irreversible and pregressive disease of the optic nerve , char. by optic disc cupping and visual field changes
why important
leading cause of irreversible blindness in the world
what is glaucoma
not a single diasease, but number of diff. with factors in common
only way to reduce chances of blindness from glaucoma
early diagnosis and treatment
6 risk factors for glaucoma
- # 1 is high IOP
- age
- fam Hx
- black
- diabetes
- shortsighted
what is IOP
balance of production and drainage of fluid
- usually under 21
what is fluid flow
made in ciliary body>around lens to ant. chamber> out through trabecular mesh to canal of schlem
what is relat. b/w glaucoma and IOP
higher IOP is higher risk, but not necc.
- IOP is neither suff. or necc. for glaucoma
what genetic risk
involved, but probably multifactorial
what is patho correlate of glaucoma
slow death of retinal ganglion cells and their axons which form the optic nerve
3 proposed mechs.
- mech injury
- vacular injury
- exitotoxicity
5 important parts of Hx
- fam Hx
- ethnic backgroud
- prior eye problems
- meds
- general health
- alergies
what is main Sx of glaucoma
none- often by the time it’s noticed, the damage is done
5 key parts of exam to find glaucoma
- vision
- IOP
- anterior chamber angle measurement
- optic nerve head exam
- visual field exam
what is tested on vision
central distance vision, not reasding
6 things to look for in the slit lamp
- cataracts
- prior surgery
- inflammation
- excess piment
- trauma
- peudo efoliation
how to look at the angle
gondioscopy - allows us to see open and closed
3 parts of fundus exam
- optic nerve damage
‘2. macular degen - other retinal problems
2 things to look for at the optic nerve
- structure of the nerve for signs of damage
2. cup to disc ration (should be under 0.6)
6 types of optic nerve changes we might see
- cupping
- disc assymetry
- notching
- excavation
- disc hemmorage
- nerve fiber layer defect
what is important about visuak field examination
change over time is the critical factor
4 typical visual field defects in glaucom
- arcuate
- paracentral
- nasal step
- constricted field
what is target in treatment
maintain a presdetermined level of pressure
3 things monitored in follow-up
- stability if the optins nerve
- visual field
- pressure
prognosis of acute angle closure
good with rapid treatment, but not if take too long
Sx of AAC glaucoma`
- halos and rrainbows around eye are most common
- NV
- red eye
- blurred central vision
signs of AAc
- v. high pressure
- conjuntival injection
- cloudy cornea
- shallow anterior chamber
mech if AAC
iris become opposed to the trabecular meshwork preventing aquous outflow
AAC risk factors
- hyperopia
- age
- F>M
- familiy
- chinese and inuit
what does penlight exam show
done on side and shows shadow on the nasal side because of swelling
acute MGMT of AAC
emergency
- instil anti-glaucoma meds
- instil miotic
- IV if necc
3 classes of treatment for AAC
meds - acutely
laser - ASAP
srug - only if necc
what is definitie mgmt of glausome
punch a hole in the eye with a laser
3 precipitating factors for attacke
- dim illumination
- stress
- druga
- esp thoe that dilate pupil
5 classes of glaucoma meds
- prostaglandin agonists
- B-blockers
- carbonic anhydrase inhibs
- a-agonists
- parasympathomimietics AAC
- hyperosmotics - acute
what is gold standard meds
B-blocker - but has same SE as other B blockers
mech of carbonic anhydrase inhibs
decrease aqueus production
what is laser therapy
laser aimed at trabecular meshwork and the healing causes drainage - don’t know why
