Glaucoma Flashcards
POAG: IOP/vascular
2nd commonest treatable blindness cause; 1% >40yo, 5% >75yo
optic disc cupping (NaSTy) + atrophy: blurry, ?pale
VF defects, tunnel vision
often aSx and asymmetrical but usually bilateral
RF: age, FHx, myopia, IOP, black, DM
PACG: iris blocks meshwork
F>M (4x), bilateral, 0.1% >40yo
high pressure: painm N&V, blurry vision, worse AM (dilates)
corneal oedema, red eye, fixed mid-dilated pupil
optic disc: cupping, atrophy, acute LOV/VFD
RF: hypermetropia, FHx
Rx: pilocarpine acetazolamide, iriodtomy, trabeculectomy
*treat both eyes (PPX)
rubeotic
rare; post CRVO or DR
new vessels occlude angle
pain, LOV, red eye, corneal oedema, rubeosis, pupil distortion
VFD changes (VA usually fine)
central 30o and VA preserved
paracentral scotomas: medial/superial; 12-16 nasal step/supranasal arcuate spread, then inferior temporal island eventual tunnel vision
IOP and blindness risk
IOP > 30: blind in 3y
IOP 25-30: blind in 6y
IOP 21-25: blind in 15y
15.5 average; 11-21 normal
>21 = risk of damage
can be normal pressure glaucoma
definition
progressive optic neuropathy due to IOP
structural and functional (VF) changes
assessment
history: FHx, migraine/raynauds, hypoTN, blood loss, age
CDR and IOP (normal 11-21)
VFE + VA
gonioscopy: brown band (meshwork), Schwalbe’s line (endothelium)
secondary causes
inflammation e.g. uveitis neovascular e.g. DR, CRVO
pigment dispersion syndrome
pseudoexfoliation syndrome
traumatic hyphaema
not due to drainage system; affects aqueous dynamics
medical treatment
see pharma
A/B/C: production
PG/A/pilocarpine: drainage
argon/YAG laser: trabeculoplasy/iridotomy
trabeculectomy
Surgical treatment
trabeculoplasty: laser; holes for drainage
* needs open angle to work
trabeculectomy:
uveoscleral fistual; creates conjunctival bleb for drainage
50-90% success (IOP
