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Ophthalmology > Glaucoma > Flashcards

Glaucoma Flashcards

1
Q

Where is aqueous produced and secreted into?

A

Produced in the ciliary body and secreted into the posterior chamber.

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2
Q

How does aqueous drain from the eye?

A

It drains from the anterior chamber via the trabecular meshwork into the canals of Schlemm.

Then to the collecting channels

Finally into the venous system.

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3
Q

What is the average intra-ocular pressure (IOP)?

A

15.5mmHg

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4
Q

At what value is IOP dangerously high?

A

21 mmHg, however damage can occur at lower values.

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5
Q

What is the 1st and 2nd commonest cause of treatable blindness in the developed world?

A

1st –> cataracts

2nd –> Progressive open angled glaucoma

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6
Q

What % of 40 y/o’s and 75 y/o’s are affected by progressive open angled glaucoma?

A

1% of over 40’s

5% of over 75’s

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7
Q

What are the risk factors for primary open angled glaucoma?

A 
IOP
family history (most important)
myopia (short sightedness)
black race
diabetes
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8
Q

Explain the pathology of progressive open angle glaucoma.

A

Raised IOP +/- vascular factors damage the retinal nerve fibres leading to their atrophy. This cause optic disk excavation (pathological cupping).

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9
Q

How does the death of optic nerve fibres in glaucoma manifest itself in the patients vision?

A

Visual field defects, then
Tunnel vision, then
Blindness

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10
Q

At what point does glaucoma present and why?

A

Late until the patient is almost blind. As they are asymptomatic for a long time.

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11
Q

Is glaucoma generally equal in both eyes?

A

No one eye generally leads the way

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12
Q

What regular investigations should be done for glaucoma patients?

A

fundoscopy
visual fields
check IOP

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13
Q

What should you see on fundoscopy in an eye with glaucoma?

A 
Pathological cupping (gets worse in the order inferiorly then superiorly, then nasal then temporal. ISNT)
Blurring of cup edges
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14
Q

What are the symptoms of acute angle closure glaucoma?

A

pain due to high pressure
blurred vision
vomiting

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15
Q

What are the three main types of glaucoma?

A

primary open angled glaucoma

acute angle closure glaucoma

Rubeotic glaucoma

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16
Q

What signs would you see with acute angle closure glaucoma?

A

Corneal oedema
Red eye
Fixed mid-dilated pupil (as the iris is stuck to the lens)

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17
Q

What are the risk factors for developing acute angle closure glaucoma?

A

Hypermetropia (long-sighted)

Family history

18
Q

What is the treatment for progressive open angle glaucoma?

A 
pilocarpine (parasympathomimetic) or
acetazolamide (carbonic anhydrase inhibitor) or
prostaglandin analogues or
beta blockers or
alpha agonists

laser iridotomy or surgical trabeculectomy

19
Q

Explain the pathology of acute angle closure glaucoma.

A

Lens grows bigger with age
Pushes iris closer to trabecular meshwork
pressure builds as aqueous still produced but cannot drain.

20
Q

What can help stave off acute angle closure for a while?

A

going to bed as this causes pupil constiction and thus the pupil pulls away from the trabecular meshwork allowing drainage

21
Q

What is the treatment for acute angle closure glaucoma?

A

pilocarpine (parasympathomimetic) +
acetazolamide (carbonic anhydrase inhibitor)

laser iridotomy or surgical trabeculectomy

22
Q

Explain the pathology of rubeotic glaucoma.

A

New vessels form and occlude the angle due to diabetic retinopathy or central retinal vein occlusion.

23
Q

How common is rubeotic glaucoma?

A

It is rare

24
Q

What are the symptoms of rubeotic glaucoma?

A

pain

reduced vision

25
Q

What are the signs of rubeotic glaucoma?

A

red eye
corneal oedema
rubeosis
pupil distortion

26
Q

How do prostaglandin analogues lower IOP? (give an example drug)

A

Enhance uveoscleral outflow and may also have some effect on the trabecular meshwork. (latanoprost)

27
Q

How do beta-blockers lower IOP? (give an example drug)

A

slows down aqueous production from the ciliary body (timolol)

28
Q

How do carbonic anhydrase inhibitors lower IOP? (give an example drug)

A

slows down aqueous production. (dorzolamide)

29
Q

How do alpha agonists lower IOP? (give an example drug)

A

Decreasing aqueous humor production and increasing uveoscleral outflow (brimonidine)

30
Q

How does pilocarpine lower IOP?

A

Increases outflow by causing contraction of the sphincter pupilae thus opening the angle. (it is a sympathomimetic)

31
Q

Most forms of treatment for glaucoma are eye drops but what can be taken orally?

A

carbonic anhydrase inhibitors can be taken orally or via drops

32
Q

What are the two types of laser used to lower IOP?

A

laser iridotomy (argon laser) or selective laser trabeculoplasty.

33
Q

What are the side-effects for beta-blocker eye drops?

A

cardiac and respiratory effects

34
Q

What are the side-effects for alpha-agonist eye drops?

A

dizziness
syncope
allergy

35
Q

What are the side-effects for prostaglandin analogue eye drops?

A

eye lash growth

iris pigmentation

36
Q

What are the side-effects for pilocarpine eye drops?

A

eye ache

poor vision in low light

37
Q

What are the side-effects for carbonic anhydrase inhibitor eye drops?

A

acidosis

taste problems

38
Q

Describe laser trabeculoplasty

A

where 50-100 shots are delivered around the trabecular meshwork to try to increase drainage.

39
Q

For whom is laser trabeculoplasty used for?

A

used in most age groups and even as a primary treatment. This requires an open angle.

40
Q

Describe trabeculectomy.

A

creates a controlled fistula where aqueous leaks out under the conjunctiva.

The surgery results in a drainage bleb

41
Q

What are the potential complications with trabeculectomy?

A

1) The surgery results in a drainage bleb and creates a open pathway for infection to get into the internal aspect of the eye.

This is a risk for the rest of the patient’s life and is an ophthalmic emergency.

2) Failure of the treatment where the conjunctiva heals and forms scar tissue.`

42
Q

Explain the prognosis of open-angled glaucoma with regards to IOP.

A

IOP 21-25 – blind in 15 years
IOP 25-30 – blind in 6 years
IOP >30 – blind in 3 years

Ophthalmology (13 decks)

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