Glaucoma Flashcards
The apposition of iris to the trabecular meshwork, which results in increased intraocular pressure:
Angle-Closure Glaucoma
Suddenly symptoms of blurred vision, seeing haloes around lights, red eye, pain, headache, nausea and vomiting:
Acute Angle-Closure Glaucoma presentation
The sudden and severe IOP elevation can quickly damage the optic nerve, resulting in:
Acute Angle-Closure Glaucoma
Is a true ophthalmic emergency, and a delay in treatment can result in blindness:
Acute Angle-Closure Glaucoma
When the pupil is mid-dilated, the distance between the iris and the lens is the shortest and can come into contact in individuals at risk for angle closure. When this occurs, aqueous humor cannot flow through the pupil into the anterior chamber, pushing the iris against the trabecular meshwork, so the aqueous humor cannot flow out of the eye, increasing IOP:
Pathophysiology
The normal IOP is:
10-21mmHg
In AACG, the IOP typically exceeds:
40mmHg
Pupillary block, Plateau iris, Use of medications, Increased iris thickness, Increased iris volume with dilation, Hyperopia, and Increased lens thickness in phacomorphic angle closure:
Mechanisms that can contribute to primary angle closure
AACG is more common in:
+40 years, Women, Asian persons, Persons with hyperopia, +Family history and Who have had AACG in one eye
Is a medical emergency that needs to be treated immediately:
AACG
Even with immediate treatment, AAC may result in:
Vision loss
Haloes and blurry vision result from
Corneal edema
The attack may have been precipitated by pupillary dilation, which may result from activities such as:
Movie theater, Taking medications that contain antihistamine or Using dilating eye drops
occluded anterior chamber angle in the affected eye and predisposing angle configuration (narrow occludable angle) in the contralateral unaffected eye (ophthalmic exam):
Gonioscopic visualization
Tonometry demonstrates:
An elevated IOP
Conjunctival injection, Fixed or sluggish and mid-dilated pupil, Shallow anterior chamber, Corneal epithelial edema and Bullae, and Flare (ophthalmic exam):
Slit-lamp exam
May reveal a swollen optic disc in an acute attack:
Ophthalmoscopy
May reveal a excavation if episodes have been chronic or repetitive:
Ophthalmoscopy
Vesicles on the anterior subcapsular lens
Glaucoma flecks
the most common cause of AACG:
Pupillary block
Persons with susceptible anatomy have a narrow occludable angle, usually of less than:
20°
HCTZ, Sulfamethoxazole and Topiramate:
Medications that can cause AACG
“Individuals with hyperopia have ______ eyes, with shorter diameter, so the intraocular structures are spaced closer together”:
Smaller
“Lens volume _________ with age and can decrease the amount of space in the anterior chamber”:
Increases
Ultrasound biomicroscopy and Anterior segment optical coherence tomography:
Imaging studies
The definitive treatment of AACG is:
Surgical
Lowering the IOP minimizes damage to the:
Optic nerve
If the IOP cannot be lowered sufficiently with meds:
Anterior Chamber Paracentesis
Are used to help clear up the cornea, to reduce intraocular inflammation and to decrease iris edema:
Mediations for eye pressure and inflammation
“In some cases, a _____ agent is used to prevent AAC recurrence”:
Miotic
The treatment of choice for pupillary-block:
Laser iridotomy
“If the cornea is extremely cloudy or the iris is too thick and an opening cannot be created using laser, _____________________ can be performed”:
Incisional peripheral iridectomy
“If the patient has both a narrow occludable angle and a visually significant cataract (blurry vision due to cataract), ____________ is the treatment of choice”
Cataract surgery
Meds:
Alpha-adrenergic agonists, Beta-blockers, Miotic agents, Carbonic anhydrase inhibitors and Prostaglandin
Brimonidine and Apraclonidine
Alpha-adrenergic agonists
Levobunolol, Betaxolol and Timolol:
Beta-blockers
Pilocarpine:
Miotic agents
Acetazolamide, Methazolamide, Dorzolamide and Brinzolamide:
Carbonic anhydrase inhibitors
Latanoprost, Travoprost and Bimatoprost:
Prostaglandin
Acute Glaucoma Treatment (First 60min):
Pilocarpina 2%, Timolol, Brimonidina, Acetazolamida oral, Corticoide topico ou Indentacao Corneana
Se após tratamento a PIO diminui, pupila se contrai e a córnea fica clara:
Crise Bloqueada -> Iridotomia com Laser
Após Iridotomia com Laser:
Timolol, Brimonidina e Corticóide tópico
Se após tratamento permanecer com a crise não bloqueada:
Manitol Venoso —> Cirurgia
