Glaucoma

Question 1

define ciliary body

Answer 1

Part of the uvea,

It’s involved in accommodation, aqueous humour secretion and influences aqueous outflow

Question 2

Normal IOP? When would damage start to occur?

Answer 2

15.5

21

Question 3

IOP> 30= blind in how many years?
25-30?
21-25?

Answer 3

3
6
15

Question 4

Examination of Acute Glaucoma

Answer 4

Red eye
Steamy cornea= oedema
Mid-dilated pupil

Question 5

Risk factors for AG

Triggers?

Answer 5

Hypermetropia
Elderly
FMH

Sunshine, mydriatic drops, cinema

Question 6

Why do elderly people get acute glaucoma?

Answer 6

Lens thickening means with age it pushes the iris closer to the trabecular meshwork until it reaches a critical point in blocking off the drainage of humour into the canals of schlemm and venous system

Question 7

History for AG

Answer 7

sudden onset pain
reduced vision
blurry
seeing haloes
maybe N&V

Question 8

The cup on the plate ‘isn’t’ yours?

Answer 8

Remember that the cup is the smaller circle: it is a size ratio of 0.4 to the disc.
This ratio is largest inferiorly, then superiorly, nasally then temporally

Question 9

How do you map visual fields?

Answer 9

Automated perimetry

Question 10

Ex and Ix for glaucoma

Answer 10

Examination: fundoscopy, peripheral field examination

Ix:
Measure IOP by slit-lamp
Gonioscopy to ID closed angle
Automated perimetry

Question 11

Which drugs reduce aq production

Answer 11

B-blockers, brimonide, diamox

Question 12

SEs for B blockers, alpha agonists?

Answer 12

HR increase, respitory effects

dizzy, syncope, allergy

Question 13

What are dorzolamide and brinzolamide? What are the issues with these drugs?

Answer 13

carbonic anhydrase inhibitors

Question 14

Side effects with PG analogues?

Answer 14

Latanoprost can cause lash growth and iris pigmentation

Question 15

Which drugs increase outflow?

Answer 15

Pilocarpine

Question 16

SEs for pilocarpine?

Answer 16

eye pain/headache, dim vision.

Question 17

Most effective drug?

Answer 17

Latanoprost

Question 18

Which can be taken PO?

Answer 18

diamox

Question 19

Which are the CA inhibitors?

Answer 19

Dorzolamide, brinzolamide, diamox

Question 20

Which work in combination with beta blockers?

Answer 20

alpha agonists (brimonidine), latanoprost, Dorzolamide, brinzolamide and diamox

Question 21

What is the laser treatment?

Answer 21

Laser trabeculoplasty

Question 22

What is the surgical treatment?

Answer 22

Trabeculectomy: fistula to cause drainage under the conjunctiva

Question 23

Who is contraindicated for surgery?

Answer 23

Pilocarpine
black
prv surgery
hx of uveitis 
diabetic (esp retinopathy)

Question 24

Which drugs taste bitter?

Answer 24

Dorzolamide, brinzolamide

Question 25

Which drug is cholinergic ?

Answer 25

Pilocarpine

Question 26

What drug is an alpha agonist? SEs?

Answer 26

Brimonidine. Dry mouth, blurred vision, allergy, burning and stinging

Question 27

Rubeotic glaucoma?

Answer 27

Neovascular glaucoma:
New vessel formation (retinopathy), central retinal vein occulsion leads to sudden closure of angle
red eye, cloudy cornea, pupil disortion and rubeosis

Presents over 1-2 weels
Might be longer history of vision loss due to ischaemia

Supportive treatment with steroid drops

Question 28

Treat AG??

Answer 28

IV acetazolamide (diamox) plus topical timolol
analgesia
IV glycerol or mannitol
Pilocarpine once IOP down 
Laser iridotomy
Surgical iridotomy