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CP2 Ophthlamology > Glaucoma > Flashcards

Glaucoma Flashcards

1
Q

Glaucoma

A

Characteristic changes in the optic nn head –> loss of visual field

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2
Q

Where is aq humour produced?

A

Ciliary body

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3
Q

How does aq drain?

A

Via trabecular meshwork

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4
Q

Where does the aq go after the trabecular meshwork?

A

Schlemm’s canal –> collecting channels –> venous system

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5
Q

What is normal intraocular pressure?

A

10-22mmHg

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6
Q

How much can IOP vary throughout the day?

A

by 5mmHg

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7
Q

When is IOP the highest?

A

At night

In the morning

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8
Q

What 2 things are IOP determined by?

A

Rate aq production

Resistance aq drainage

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9
Q

Which structural changes would suggest glaucoma (4)

A

Incr cup size
Asymmetrical cupping
Notching rim, vertical elongation
Vessels nasally displaced, bayonetted

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10
Q

What is the ISNT rule?

A

In normal disc:

Size inferior > superior > nasal > temporal

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11
Q

How do you test IOP?

A

Goldmann tonometer

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12
Q

What is a normal cup: disc

A

0.3

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13
Q

What is the normal colour of the optic disc?

A

Salmon pink

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14
Q

What are the 2 types of glaucoma?

A

Primary open angle glaucoma

Acute angle closure glaucoma

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15
Q

What Sx do you get with POAG?

A

Visual field defects (peripheral initially)

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16
Q

What % >40s have POAG

A

1%

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17
Q

What % >75s have POAG?

A

5%

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18
Q

Risk Factors POAG (6)

A 
Raised IOP
FHx 
Myopia 
Afro-Carribean 
DM
Steriods
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19
Q

What cup:disc would be definitely pathological?

A

0.7

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20
Q

What happens to the optic disc colour as POAG progresses?

A

Disc becomes pale

21
Q

What is a physiological scotoma? Where is it

A

Blind spot

@ optic disc, 15’ temporally

22
Q

How is the open angle measured?

A

gonioscopy

23
Q

E.g.s of drugs used to Tx POAG

A 
PG analogues - TO latanoprost 
B-blockers - timolol drops 
A-adrenergic - Apraclonidine drops 
CAH inhibitors - dorzolamide, acetazolamide 
Miotics - pilocarpine TO
24
Q

Surgical options for POAG (2)

A

Argon laser trabeculoplasty

Surgical trabeculectomy

25
Q

Action latanoprost

A

Increases uveoscleral aq outflow

26
Q

SE latanoprost

A

Red eye
Iris colour change
Eyelash growth
Periocular skin pigmentation

27
Q

Action timolol

A

Decr aq production

28
Q

SE timolol

A 
Dry eyes
Corneal anaesthesia 
Bradycardia 
Bronchospasm 
Depression
29
Q

Action Apraclonidine

A

Decr aq production

Incr uvescleral outflow

30
Q

SE apraclonidine

A 
Mydriasis 
Lethargy 
Dry mouth 
HTN 
risk hypertensive crisis if on MAOIs
31
Q

Action dorzolamide

A

Decr aq production

32
Q

SE dorzolamide

A

Pain

Local allergic reaction

33
Q

When should use of acetazlamide be used ith caution>

A

pregnancy

renal stones Hx

34
Q

SE acetazalimide?

A

Met acidosis
Hypokalaemia
Paraesthesia
GI disturbance

35
Q

Action pilocarpine

A

Contricts pupil, unblocks trabecular meshwork

36
Q

C/I pilocarpine

A

Ant uveitis
High myopia
Retinal detachment
Aphakia

37
Q

SE pilocarpine

A

Decr acuity

Brow ache for ciliary mm spasm

38
Q

Pathophysiology of acute angle closure glaucoma

A

Lens becomes pushed against iris –> pupillary block
Build up of aq in posterior chamber + bulging of iris + closure of iridocorneal angle
Blocks trabecular meshwork

39
Q

Risk factors AACG (4)

A

F (4:!)
Asians
Shallow anterior chamber
Shorter axial length

40
Q

2’ causes of AACG

A

Uveitis
NV - DM, retinal vv occlusion
Pigment dispersion syndrome
Traumatic hyphaema

41
Q

Sx AACG (4)

A

Pain
N+V
Blurred vision
Halo’s

42
Q

Signs AACG (5)

A 
Brick red eye 
Cloudy cornea 
Fixed mid-dilated pupil 
IOP >21mmHg 
Closed iridocorneal angle on gonioscopy
43
Q

3 Mx steps of AACG

A

Topical
Systemic
Laser Tx

44
Q

Eye drops used AACG

A

Timolol

Apraclonidine

45
Q

Once IOP in AACG is <50 what should you prescribe?

A

Miotic

46
Q

Systemic Tx AACG

A

IV CAH - acetazolamide
IV hyperosmotic e.g. mannitol
Analgesia, antiemetics

47
Q

When to use laser trabeculectomy in AACG

A

ASAP in contralateral eye

+ within a week in eye affected

48
Q

When to use trabeculectomy in AACG?

A

Resistant cases

CP2 Ophthlamology (11 decks)

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