Glaucoma

Question 1

What is glaucoma?

Answer 1

Progressive neuropathy characterised by optic nerve damage and vision loss

It is thought to be treated to high intraocular pressure but this mechanism is poorly understood

Question 2

What is the pathogenesis of closed angle glaucoma?

Answer 2

Increased intraocular pressure blocks iridocorneal angle (this is where aqueous humour drains into anterior chamber) resulting in a very painful increase in intraocular pressure which damages the optic nerve

Question 3

How does closed angle glaucoma present?

Answer 3

Severely pain
Red eye
Vomiting
Visual loss
Dilated pupil
Stony hard eye

Question 4

What is the management of acute closed angle glaucoma?

Answer 4

Laser iridotomy (small hole in iris allows fluid to drain through bypassing the iridocorneal angle)

Question 5

What is the pathogenesis of open angle glaucoma?

Answer 5

Increased corneal pressure from resistance to aqueous outflow causing optic disc cupping

Question 6

How does open angle glaucoma present?

Answer 6

Often asymptomatic

Question 7

What would be seen on fundoscopy in open angle glaucoma?

Answer 7

Cupped disc (pale, wide cup with cup-disc ratio close to 1)

Question 8

How is open angle glaucoma managed?

Answer 8

Eye drops to lower intraocular pressure

Question 9

What 3 classes of drugs can be used to lower intraocular pressure?

Answer 9

Protanoids (bimatoprost)

ß-blockers (e.g. timolol)

Carbonic anhydrase inhibitors (e.g. dorzalomide)

Question 10

What do prostanoid drugs end in?

Answer 10

____prost

Question 11

What do carbonic anhydrase inhibitors end in?

Answer 11

___lamide

Question 12

Why is combination therapy often used in glaucoma?

Name a combination therapy which can be used.

Answer 12

Compliance is a big issue

Cosopt (dorzolamide and timolol)