Glaucoma Flashcards
Primary open angle glaucoma
Description
Chronic, progressive optic neuropathy w loss of optic n fibres
Primary open angle glaucoma
Characteristics
Adult onset IOP > 21mmHg Optic disc cupping Progressive visual field loss Open + normal anterior chamber
NB in Primary open angle glaucoma
Asymptomatic but blinding eye condition therefore must screen
Symptomatic at advanced stage and central vision threatened
Primary open angle glaucoma
Risk factors
Age > 40 years High IOP Asymmetry of 4mmHg IOP Race (black population) Diabetes Genetic (1st degree relatives) Myopia Contraceptive pill Steroid responsiveness Thin cornea
Primary open angle glaucoma
Investigations
Tonometry Genioscope Pachymetry Perimetry Fundoscopy U/S for corneal thickness
Primary open angle glaucoma
Significance of IOP measurement time
> morning than evening
increase with steroids, ICP, tight shirt collar, Grave’s
Primary open angle glaucoma management
AIM: decrease IOP
Medical vs surgical
Suppression of aqueous formation or increase of aqueous outflow
Primary open angle glaucoma
Medical management
Prostaglandin analogues
Carbonic anhydrase inhibitor
Beta blocker
Alpha-2 agonists
Prostaglandin analogues
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
Beta blockers
Decrease aqueous production
Topical
Timolol, betaxolol, levobunolol
S/E ocular allergy, punctate keratitis, bronchospasm, CVS d/o, sleep d/o
Alpha-2 agonists
Decrease aqueous production
Topical
Brimonidine, apraclonidine
C/I children <2yo
Carbonic anhydrase inhibitors
Inhibit aqueous secretion
Topical and oral
Acetazolamide (diamox)
S/E hypokalemia, GIT d/o, paresthesia
Primary open angle glaucoma
Surgical management
Trabeculectomy
Drainage devices
Argon laser trabeculoplasty
Normal tension glaucoma
POAG variant
NORMAL IOP
No secondary glaucoma features
Acute angle closure glaucoma
Description
OPHTHALM EMERGENCY Acute onset Painful Unilateral High IOP + rapid loss of vision (severe and often permanent if untreated)
Acute angle closure glaucoma
Risk factors
Hypermetropia Shallow ant chamber depth Gender (F>M) Race (asians) DM Trauma
Acute angle closure glaucoma
Clinical features
Painful red eye
Hazy cornea
Pupil abn (unrx middilated)
Decreased VA Shallow ant chamber N + V Loss of red reflex Narrow angle on gonioscopy
Acute angle closure glaucoma
Management
Acetazolamde Mannitol, glycerol, isosorbide (osmotics) Analgesia Anti-emetics Pilocarpine to reduce pupil block Laser iridotomy -> surgical iridotomy
Secondary glaucoma
Description
Open OR closed
Can present as either
Secondary glaucoma
Causes
Inflammation Lens abnormality Steroid therapy Intraocular tumour Iris neovascularisation Hyphema Pigment dispersion Pseudoexfoliation
Secondary glaucoma
Management
First treat cause then standard glaucoma treatment
Inflammation - steroids
Retinal ischemia - retinal photocoagulation
Lens induced - cataract removal
Trabeculectomy
Drainage device
Congenital glaucoma
Description
Abnormal development of ant chamber angle w/wo other congenital conditions
Congenital glaucoma
Clinical findings
Watery asymmetrical eyes Photophobia Blepharospasm Hazy cornea Buphthalmos Optic disc cupping
Ocular HT
Raised pressure without optic n damage and visual field loss
Benign but be careful
Congenital glaucoma
Treatment
Goniotomy
Trabeculotomy
