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Eyes > Glaucoma > Flashcards

Glaucoma Flashcards

1
Q

What is glaucoma?

A

Progressive optic neuropathy

elevated intraocular pressure elevated IOP damages the normal visual process

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2
Q

What are the main factors that influence the level of IOP in the eye?

A

the rate of aqueous humour production

the resistance of the drainage of the aqueous humour

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3
Q

Which investigations are performed in glaucoma?

A

cup disc ratio
IOP measurement
visual field analysis
visual acuity

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4
Q

What disability is associated with glaucoma?

A

significant peripheral field loss may result in patient unable to legally drive
advanced glaucoma results in permanent blindness

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5
Q

How is glaucoma classified?

A

1 - open angle glaucoma

2 - angle closure glaucoma

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6
Q

How is primary open angle glaucoma classified?

POAG

A

1 - elevated IOP of >21mmHg
2 - open angle
3 - glaucomatous cupping and visual field loss

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7
Q

Describe primary open angle glaucoma

A

chronic, slowly progressive and usually bilateral disease

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8
Q

What causes the rise in IOP in POAG?

A

increased resistance of the drainage channels in the angles of eye such as the trabecular meshwork

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9
Q

How does POAG present?

A

usually asymptomatic due to its incidious onset, until is causes significant visual field loss

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10
Q

How is POAG managed/treated?

A

involves reducing IOP, monitoring visual fields and visual acuity

Treatment options
1 - medical therapy
2 - argon laser trabeculoplasty
3 - surgical - trabeculectomy

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11
Q

What is the medical therapy used for POAG?

List the topical drugs used

A

aim is to achieve reduction of IOP to prevent further optic nerve damage

topical drug treatment is initiated:

  • beta blockers
  • prostaglandin agonist
  • alpha adrenergic agonist
  • topical carbonic anhydrase inhibitors
  • miotics
  • systemic carbonic anhydrase inhibitors
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12
Q

What is primary angle-closure glaucoma?Unilateral/bilateral?

A

a condition whereby the obstruction to the aqueous outflow (drainage) is due to the closure of the angle by the peripheral iris frequently BILATERAL predominant in females

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13
Q

How does PAOG progress?

A

raised IOP +/- vascular factors –> loss of retinal nerve fibres –> optic disc excavation (cupping) –> visual field defects –> tunnel vision –> blindness

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14
Q

How is POAG detected?

A 
asymptomatic until almost blind
screening early to detect cases
optic disc examination
intraocular pressure readings 
visual field analysis
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15
Q

Which method is used to assess visual fields?

A

Humphrey - gold standard

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16
Q

What are the complications of beta blockers?

A

cardiac & respiratory effects

17
Q

What are the complications of alpha agonists?

A

dizziness
syncopy
allergy

18
Q

What are the complications of prostaglandin analogues?

A

lash growth

pigmentation

19
Q

What are the complications of cholinergic?

A

eye ache

dim vision

20
Q

What are the complications of carbonic anhydrase inhibitors?

A

taste problems

acidosis

21
Q

What are the new advances in topical medications?

A

longer acting agents
combination agents
preservative free drops

22
Q

What are the symptoms of acute angle closure glaucoma?

A

pain
blurred vision
vomiting

23
Q

What are the signs of acute angle closure glaucoma?

A

corneal oedema
red eye
fixed mid-dilated pupil

24
Q

What are the risk factors for angle closure glaucoma?

A

shallow anterior chamber
hypermetropia
FH

25
Q

How is acute closure glaucoma treated?

A

EMERGENCY SITUATION

  • aim to reduce IOP
  • intensive miotic therapy e.g. pilocarpine eye drops every 5 mins
  • drugs that reduce the aqueous secretion e.g. IV or oral acetazolamide
  • analgesics and antiemetics good for pain and N&V
26
Q

What permanent treatment is used after the acute phase in closed angle glaucoma?

A

peripheral laser iridotomy is performed in both eyes

trabeculectomy surgery may be required in resistant cases

27
Q

What are the secondary causes known to interfere with aqueous humour dynamics?

A
  • Inflammation e.g. uveitis
  • Neovascular e.g. secondary to diabetic retinopathy, CRVO
  • Pigment dispersion syndrome
  • Pseudoexfoliation syndrome
  • Traumatic hyphaema
28
Q

What is rubeotic glaucoma?

A

new vessels occlude angle causes - CRVO or diabetic retinopathy

Eyes (11 decks)

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