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Head and Neck > Glaucoma > Flashcards

Glaucoma Flashcards

1
Q

What is glaucoma?

A

Impaired outflow of aqueous humour from the anterior chamber causes raised intraocular pressure leading to progressive optic neuropathy involving characteristic changes to optic nerve head.

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2
Q

What is glaucoma?

A

Impaired outflow of aqueous humour from the anterior chamber causes raised intraocular pressure leading to progressive optic neuropathy involving characteristic changes to optic nerve head.

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3
Q

Describe the production and flow of aqueous?

A

Aqueous is produced by the ciliary body and flows from the posterior chamber to the anterior chamber through the pupil; drains into the episcleral veins via the trabecular meshwork and the Canal of Schlemm

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4
Q

What is an isolated increase in IOP termed? Mx?

A

Ocular HTN. Should be followed for increased risk of developing glaucoma.

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5
Q

What IOP is more likely to be associated with glaucoma?

A

Pressures >21mmHg more likely to develop glaucoma

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6
Q

Progression of glaucoma development?

A

Gradual pressure rise -> increased C:D ratio -> visual field loss. Loss of peripherals generally precedes loss of central vision.

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7
Q

Ix in glaucoma?

A
  • Hx inc FHx
  • VA testing
  • Slit lamp to assess anterior chamber depth
  • opthalmoscopy to assess disc features
  • Visual field testing
  • Tonometry by application or indentation to measure IOP
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8
Q

What is primary open angle glaucoma?

A

-Most common (>95% cases)
Due to obstruction of aqueous drainage within the trabecular meshwork and its drainage into the canal of Schlemm. Very insidious!!

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9
Q

What is the average IOP?

A

15mmHg +/- 3

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10
Q

What is the normal Cup:Disc ratio?

A
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11
Q

When should glaucoma be suspected in relation to C:D ratio?

A
  • > 0.6
  • C:D ratio b/w eyes >0.2
  • Cup approaches disc margin
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12
Q

What are the RFx for primary open angle glaucoma?

A

A FIAT

  • Age (increased)
  • FHx (2-3x inc risk)
  • IOP (>21mmHg)
  • African descent
  • Thin cornea
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13
Q

Glaucoma bilateral or unilateral?

A

Bilateral but usually asymmetric

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14
Q

What are the optic disc changes in glaucoma?

A
  • Increased C:D ratio / C:D asymmetry >0.2 b/w eyes
  • thinning of neuroretinal rim
  • flame shaped disc haemorrhage
  • 360” peripapillary atrophy
  • nerve fibre layer defect
  • large vessels become nasally displaced
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15
Q

Characteristic visual defects in glaucoma?

A 
Slow peripheral loss of vision
-Paracentral defects
-Arcuate scotoma
-Nasal step
Late loss of central vision if untreated
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16
Q

Medical treatment options in glaucoma management?

A
  • Increase aqueous outflow
  • -> topical cholinergics
  • -> topical PG analogues
  • -> topical a-adrenergics
  • Decrease aqueous production
  • ->topical B blockers
  • -> topica/oral carbonic anhydrase inhibitor
  • -> topical a-adrenergics
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17
Q

Monitoring in glaucoma?

A
  • serial optic nerve head examination
  • IOP measurement
  • visual field testing
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18
Q

Surgical management of glaucoma?

A
  • Laser trabeculoplasty
  • Cyclophotocoagulation (selective destruction of ciliary body)
  • Trabeculectoy
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19
Q

What is primary angle closure glaucoma?

A

PACG 5% glaucoma cases.

  • peripheral iris bows forward in susceptible eye with shallow anterior chamber; obstructs aqueous access to trabecular meshwork.
  • sudden forward shift of lens-iris diaphragm causes pupillary block, inability of aqueous to flow from posterior chamber to anterior chamber –> sudden rise in IOP
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20
Q

RFx PACG?

A
  • Hyperopia: small eye, big lens
  • Age >70
  • Female
  • FHx
  • Asian / Inuit
  • Mature cataracts
  • Shallow anterior chamber
21
Q

Mx primary angle closure glaucoma?

A

BACH

  • B blockers and miotics
  • Adrenergics
  • Cholinergics
  • Hyperosmotic agents
22
Q

CFx PACG?

A
  • Red painful eye
  • Unilateral (but other eye increased risk)
  • Decreased VA
  • Halos around lights
  • N/V/Abdo pain
  • Fixed, mid-dilated pupil
  • Corneal oedema w/ conjunctival injection
  • Marked IOP increase
23
Q

Why does PACG lead to decreased VA?

A

Vision acutely blurred from corneal oedema

24
Q

Mx PACG?

A
  • Refer opthal : EMERGENCY

- Requires laser iridotomy, aqueous suppressants and hyper osmotic agents

25
Q

Mx PACG?

A
  • Refer opthal : EMERGENCY

- Requires laser iridotom, aqueous suppressants and hyper osmotic agents

26
Q

Describe the production and flow of aqueous?

A

Aqueous is produced by the ciliary body and flows from the posterior chamber to the anterior chamber through the pupil; drains into the episcleral veins via the trabecular meshwork and the Canal of Schlemm

27
Q

What is an isolated increase in IOP termed? Mx?

A

Ocular HTN. Should be followed for increased risk of developing glaucoma.

28
Q

What IOP is more likely to be associated with glaucoma?

A

Pressures >21mmHg more likely to develop glaucoma

29
Q

Progression of glaucoma development?

A

Gradual pressure rise -> increased C:D ratio -> visual field loss. Loss of peripherals generally precedes loss of central vision.

30
Q

Ix in glaucoma?

A
  • Hx inc FHx
  • VA testing
  • Slit lamp to assess anterior chamber depth
  • opthalmoscopy to assess disc features
  • Visual field testing
  • Tonometry by application or indentation to measure IOP
31
Q

What is primary open angle glaucoma?

A

-Most common (>95% cases)
Due to obstruction of aqueous drainage within the trabecular meshwork and its drainage into the canal of Schlemm. Very insidious!!

32
Q

What is the average IOP?

A

15mmHg +/- 3

33
Q

What is the normal Cup:Disc ratio?

A

N C:D =

34
Q

When should glaucoma be suspected in relation to C:D ratio?

A
  • > 0.6
  • C:D ratio b/w eyes >0.2
  • Cup approaches disc margin
35
Q

What are the RFx for primary open angle glaucoma?

A

A FIAT

  • Age (increased)
  • FHx (2-3x inc risk)
  • IOP (>21mmHg)
  • African descent
  • Thin cornea
36
Q

Glaucoma bilateral or unilateral?

A

Bilateral but usually asymmetric

37
Q

What are the optic disc changes in glaucoma?

A
  • Increased C:D ratio / C:D asymmetry >0.2 b/w eyes
  • thinning of neuroretinal rim
  • flame shaped disc haemorrhage
  • 360” peripapillary atrophy
  • nerve fibre layer defect
  • large vessels become nasally displaced
38
Q

Characteristic visual defects in glaucoma?

A 
Slow peripheral loss of vision
-Paracentral defects
-Arcuate scotoma
-Nasal step
Late loss of central vision if untreated
39
Q

Medical treatment options in glaucoma management?

A
  • Increase aqueous outflow
  • -> topical cholinergics
  • -> topical PG analogues
  • -> topical a-adrenergics
  • Decrease aqueous production
  • ->topical B blockers
  • -> topica/oral carbonic anhydrase inhibitor
  • -> topical a-adrenergics
40
Q

Monitoring in glaucoma?

A
  • serial optic nerve head examination
  • IOP measurement
  • visual field testing
41
Q

Surgical management of glaucoma?

A
  • Laser trabeculoplasty
  • Cyclophotocoagulation (selective destruction of ciliary body)
  • Trabeculectoy
42
Q

What is primary angle closure glaucoma?

A

PACG 5% glaucoma cases.

  • peripheral iris bows forward in susceptible eye with shallow anterior chamber; obstructs aqueous access to trabecular meshwork.
  • sudden forward shift of lens-iris diaphragm causes pupillary block, inability of aqueous to flow from posterior chamber to anterior chamber –> sudden rise in IOP
43
Q

RFx PACG?

A
  • Hyperopia: small eye, big lens
  • Age >70
  • Female
  • FHx
  • Asian / Inuit
  • Mature cataracts
  • Shallow anterior chamber
44
Q

Mx primary angle closure glaucoma?

A

BACH

  • B blockers and miotics
  • Adrenergics
  • Cholinergics
  • Hyperosmotic agents
45
Q

CFx PACG?

A
  • Red painful eye
  • Unilateral (but other eye increased risk)
  • Decreased VA
  • Halos around lights
  • N/V/Abdo pain
  • Fixed, mid-dilated pupil
  • Corneal oedema w/ conjunctival injection
  • Marked IOP increase
46
Q

Why does PACG lead to decreased VA?

A

Vision acutely blurred from corneal oedema

47
Q

When is increased IOP noticeable even on palpation?

A

IOP >40mmHg

48
Q

Mx PACG?

A
  • Refer opthal : EMERGENCY

- Requires laser iridotom, aqueous suppressants and hyper osmotic agents

Head and Neck (19 decks)

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