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Clin Med I - Eye > Glaucoma > Flashcards

Glaucoma Flashcards

1
Q

What is glaucoma?

A

increased IOP damages optic nerve (cupping/optic atrophy) causing vision loss

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2
Q

Percentage of ppl with glaucoma who become blind?

A

4%

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3
Q

What is the greatest systemic risk factor for glaucoma?

A

Age; >60 most common

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4
Q

Risk factors for glaucoma?

A
  • age
  • race (AA)
  • Hx of IOP, high myopia, CVD, HTN, low BP, CAD, DM
  • family Hx
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5
Q

What causes glaucoma?

A

accelerated and exaggerated normal aging changes in anterior chamber of eye; affects schlemm’s canal and uveoscleral outflow pathway (anterior canal to angle)

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6
Q

Optic nerve head effects of glaucoma?

A
  1. swollen cup - closer to 4:1 c/d
  2. thinning of disc rim (superior and inferior notching)
  3. prog. loss of neural rim tissue
  4. disc hemorrhages
  5. loss of nerve fibers
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7
Q

visual field changes in glaucoma?

A
  • nasal field loss
  • paracentral field loss
  • mid peripheral field lossAQ
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8
Q

5 Types of glaucoma?

A
  1. primary open-angle (POAG)
  2. angle-closure
  3. congenital
  4. childhood
  5. secondary
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9
Q

POAG characteristics?

A
  • most common (90%)
  • bilateral (not always symmetric)
  • optic nerve damage
  • visual field deficit
  • adult onset
  • normal appearing anterior chamber angles
  • overproduction problem or outflow thru canal/meshwork problem
  • absence of secondary cause
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10
Q

Progression of POAG and congenital glaucoma?

A
  • asymptomatic in early stages

- can result in blindness (total optic nerve atrophy)

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11
Q

5 Causes of secondary glaucoma?

A
  1. trauma
  2. uveitis (inflammation of pigmented layer behind retina in front of sclera)
  3. chronic steroid use (COPD)
  4. DR
  5. ocular vascular occlusion
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12
Q

characteristics of neovascular glaucoma?

A

iris and anterior chamber angle neovascularized (bloody iris)

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13
Q

Is POAG more common in males or females?

A

females

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14
Q

AA risk factors for POAG?

A
  • blindness (4x)
  • age: 10% prevalence @ >70
  • earlier onset
  • more advanced upon discovery
  • elevated IOP
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15
Q

How to screen for POAG?

A
  • IOP measurements
  • optic disc evaluation
  • visual field testing
  • OCT (optical coherence tomography)
  • HRT (Heidelberg retinal tomography)
  • Pacymetery
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16
Q

What is OCT (optical coherence tomography)?

A

imaging test: uses light wave to take cross-section pictures of retina; allows you to visualize layers of the retina (and how thick they are)

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17
Q

what is the most effective screening too for glaucoma?

A

periodic comprehensive eye examinations

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18
Q

what is pachymetry?

A

measurement of corneal thickness (in microns)

normally done with U/S

average CT= 545 microns

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19
Q

How can corneal thickness effect the IOP measurement?

A

Can be interpreted as too low or high depending on corneal thickness. 10 microns=1 mm pressure
ex. Eye with 20 mm Hg; 500 micron thick cornea… real pressure = 25 mm Hg

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20
Q

Risk factor analysis: how are the levels of glaucoma risk defined?

A

high: 4 or more Risk factors
moderate: 3
low: 2 or less

21
Q

During eye exam your patient presents with normal visual fields, open/normal appearing anterior chamber angles, elevated IOP, and abnormal optic disc; would you suspect a possible case of glaucoma?

A

yes

22
Q

Tx for glaucoma?

A
  • halt further visual loss

- halt further optic nerve damage

23
Q

What do topical glaucoma medications target?

A

autonomic nervous system

24
Q

topical medications used for glaucoma?

A
  • Beta blockers (timolol, levobunolol, carteolol, metipranolol, betaxolol)
  • adrenergic agonists (epi, propine, apraclonidine, brimonidine)
  • cholinergic agonists (carbachol, echothiophate iodine, demecarium bromide)
  • oral carbonic anhydrase inhibitors (acetazolimide, methazolamide, brinzolamide, dorzolamid, dorzolomide and timolol)
  • prostoglandins (xalatan)
25
Q

What is the only selective B1 blocker for glaucoma?

A

betaxolol (betoptic or betoptic-S)

26
Q

what are the advantages of beta blockers?

A
  • minimal ocular side effects
  • systemic side effects well understood
  • one per day
  • cost
  • stabilization of visual fields with betoptic
27
Q

What are disadvantages of beta blockers?

A
  • exacerbate breathing problems
  • can’t use with CHF, bradycardia, heart block
  • decreased exercise tolerance
  • decreased HDL and increased triglycerides
  • CNS effects (depression, anxiety, confusion, hallucinations, drowsiness, weakness, memory loss, impotence)
  • decreased effect with systemic beta blockers
28
Q

Why is betoptic a good choice for pt with COPD?

A

Decreased breathing problems and increased exercise tolerance problems as opposed to non-selectives.

29
Q

What beta blocker minimizes decreased HDL and increased triglycerides?

A

ocupress

30
Q

how do adrenergic agonists effect glaucoma?

A
  • decrease aqueous production

- increase aqueous drainage

31
Q

what two alpha-2 agonist medications are used for glaucoma?

A

apraclonidine

brimonidine

32
Q

S/E of topical adrenergic agonists?

A
  • increased BP
  • tachy-arrythmias
  • tremor
  • headache
  • anxiety
  • burning in eye
  • conjunctival infection
  • pupillary dilation
  • allergic rxn
33
Q

What are the S/E of topical cholinergic agonists?

A
  • increased bronchial secretions
  • nausea
  • vomitting
  • diarrhea
  • apnea
  • increased myopia
  • eye brow pain
  • decreased vision
  • retinal detachment
34
Q

How do oral carbonic anhydrase inhibitors fxn?

A

inhibit carbonic anhydrase, an enzyme needed for aqueous fluid production

35
Q

What are the advantages of carbonic anhydrase inhibitors?

A

few systemic side effects

36
Q

what are the disadvantages of carbonic anhydrase inhibitors?

A
  • less effective than timoptic
  • allergy
  • stinging
  • cost
37
Q

S/E of oral carbonic anhydrase inhibitors?

A
  • malaise
  • anorexia
  • depression
  • paraesthesias
  • serum electrolyte abnormalities
  • renal calculi
  • aplastic anemia
  • corneal edema
38
Q

how do prostaglandins effect glaucoma?

A

increase removal of aqueous fluid

39
Q

advantages of xalantan?

A
  • equal or better IOP lowering (compared to timoptic)
  • qD
  • minimal side effects
  • increased uveoscleral outflow (good for LTG)
40
Q

what is best for low tension glaucoma’?

A

xalantan

41
Q

What are the disadvantages of prostoglandins?

A
  • iris pigmentation
  • eyelash thickening
  • new medication
  • cost
  • uveitis
  • CME (cystoid macular edema)
42
Q

why do medical treatments with glaucoma fail?

A
  • noncompliance
  • target pressures too low
  • fluctuations of IOP
43
Q

Surgical glaucomal procedures?

A
  • laser surgery (Slt)
  • filtering surgery
  • cyclodestructive surgery
  • drainage device surgery
  • trabeculoplasty
  • GDD (glaucoma drainage device/baerveldt glaucoma implant)
44
Q

Angle-closure high risk groups?

A
  • elderly
  • eskimos
  • asians
  • females
  • hyperopic patients
  • family Hx
45
Q

Symptoms of acute glaucoma?

A
  • ocular pain
  • redness
  • mid dilated pupil
  • brow pain
  • blurred vision
  • halos
  • headaches
  • nausea
  • vomiting
  • steamy cornea/eye
46
Q

How to approach suspected acute glaucoma?

A
  • eye exam
  • IOP measurement
  • initiate medical tx
47
Q

Tx for acute glaucoma (initial)?

A
  • beta blocker (timoptic) or alpha agonist (alphagan)
  • acetazolamide 500 mg PO or IV
  • oral glycerine or isosorbide (1cc/kg)
  • Mannitol 20% IV 300-500cc
  • LT follow-up
48
Q

how do beta blockers affect glaucoma?

A

decrease aq. humor production

49
Q

How should you manage pt at risk for acute angle closure glaucoma?

A

prophylactiv iridotomy if chamber angle is narrow to create large pathway for removal of fluid;

miotics (drops that stimulate the PSNS and constrict the pupil) are not a substitute

Clin Med I - Eye (5 decks)

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