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MBChB IV Ophthalmology > Glaucoma > Flashcards

Glaucoma Flashcards

1
Q

Primary open angle glaucoma

Description

A

Chronic, progressive optic neuropathy w loss of optic n fibres

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2
Q

Primary open angle glaucoma

Characteristics

A 
Adult onset
IOP > 21mmHg
Optic disc cupping
Progressive visual field loss
Open + normal anterior chamber
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3
Q

NB in Primary open angle glaucoma

A

Asymptomatic but blinding eye condition therefore must screen
Symptomatic at advanced stage and central vision threatened

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4
Q

Primary open angle glaucoma

Risk factors

A 
Age > 40 years
High IOP
Asymmetry of 4mmHg IOP
Race (black population)
Diabetes
Genetic (1st degree relatives)
Myopia
Contraceptive pill
Steroid responsiveness
Thin cornea
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5
Q

Primary open angle glaucoma

Investigations

A 
Tonometry
Genioscope
Pachymetry
Perimetry
Fundoscopy
U/S for corneal thickness
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6
Q

Primary open angle glaucoma

Significance of IOP measurement time

A

> morning than evening

increase with steroids, ICP, tight shirt collar, Grave’s

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7
Q

Primary open angle glaucoma management

A

AIM: decrease IOP
Medical vs surgical
Suppression of aqueous formation or increase of aqueous outflow

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8
Q

Primary open angle glaucoma

Medical management

A

Prostaglandin analogues
Carbonic anhydrase inhibitor
Beta blocker
Alpha-2 agonists

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9
Q

Prostaglandin analogues

A

Increase uveoscleral aqueous outflow
Latanoprost, travoprost, bimatoprost
1st line therapy - high potency, few systemic S/E
S/E - iris pigmentation, periocular skin hyperpigmentation, eyelash growth, conjunctival hyperaemia

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10
Q

Beta blockers

A

Decrease aqueous production
Topical
Timolol, betaxolol, levobunolol
S/E ocular allergy, punctate keratitis, bronchospasm, CVS d/o, sleep d/o

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11
Q

Alpha-2 agonists

A

Decrease aqueous production
Topical
Brimonidine, apraclonidine
C/I children <2yo

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12
Q

Carbonic anhydrase inhibitors

A

Inhibit aqueous secretion
Topical and oral
Acetazolamide (diamox)
S/E hypokalemia, GIT d/o, paresthesia

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13
Q

Primary open angle glaucoma

Surgical management

A

Trabeculectomy
Drainage devices
Argon laser trabeculoplasty

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14
Q

Normal tension glaucoma

A

POAG variant
NORMAL IOP
No secondary glaucoma features

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15
Q

Acute angle closure glaucoma

Description

A 
OPHTHALM EMERGENCY
Acute onset
Painful
Unilateral
High IOP + rapid loss of vision (severe and often permanent if untreated)
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16
Q

Acute angle closure glaucoma

Risk factors

A 
Hypermetropia
Shallow ant chamber depth
Gender (F>M)
Race (asians)
DM
Trauma
17
Q

Acute angle closure glaucoma

Clinical features

A

Painful red eye
Hazy cornea
Pupil abn (unrx middilated)

Decreased VA
Shallow ant chamber
N + V
Loss of red reflex
Narrow angle on gonioscopy
18
Q

Acute angle closure glaucoma

Management

A 
Acetazolamde
Mannitol, glycerol, isosorbide (osmotics)
Analgesia
Anti-emetics
Pilocarpine to reduce pupil block
Laser iridotomy -> surgical iridotomy
19
Q

Secondary glaucoma

Description

A

Open OR closed

Can present as either

20
Q

Secondary glaucoma

Causes

A 
Inflammation
Lens abnormality
Steroid therapy
Intraocular tumour
Iris neovascularisation
Hyphema
Pigment dispersion
Pseudoexfoliation
21
Q

Secondary glaucoma

Management

A

First treat cause then standard glaucoma treatment
Inflammation - steroids
Retinal ischemia - retinal photocoagulation
Lens induced - cataract removal
Trabeculectomy
Drainage device

22
Q

Congenital glaucoma

Description

A

Abnormal development of ant chamber angle w/wo other congenital conditions

23
Q

Congenital glaucoma

Clinical findings

A 
Watery asymmetrical eyes
Photophobia
Blepharospasm
Hazy cornea
Buphthalmos
Optic disc cupping
24
Q

Ocular HT

A

Raised pressure without optic n damage and visual field loss

Benign but be careful

25
Q

Congenital glaucoma

Treatment

A

Goniotomy

Trabeculotomy

MBChB IV Ophthalmology (17 decks)

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