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Ophthalmology > Glaucoma > Flashcards

Glaucoma Flashcards

1
Q

Does having a high IOP equate to a diagnosis of glaucoma?

A

No - can be made with normal IOP

But high IOP is a risk factor for development of glaucoma

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2
Q

What is the most common type of glaucoma?

A

Open angle glaucoma (chronic simple glaucoma)

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3
Q

What causes open angle glaucoma?

A

Trabecular meshwork deterioration (slow clogging)

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4
Q

What happens in open angle glaucoma?

A

Typically: rise in intra ocular pressure and damage to optic nerve (outer rim atrophy -> peripheral vision loss)
Can progress to central visual loss

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5
Q

Open angle glaucoma affects what percentage of people over 40?

A

0.5%

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6
Q

Does open angle glaucoma affect more men or women?

A

Equal

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7
Q

Other than age, what risk factors are there for open angle glaucoma?

A 
FH
African- Caribbean 
Myopia 
HTN 
DM 
Thyroid eye disease
Corticosteroids 
Screening for these high risk groups
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8
Q

Why should there be screening for open angle glaucoma?

A

Patients are asymptomatic until visual field changes advanced, at which point little can be done

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9
Q

What fundoscopy signs are seen in open angle glaucoma?

A

Optic disc cupping
Optic disc pallor indicating atrophy
Disc haemorrhages

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10
Q

What is the normal cup to disc ratio and what is seen in open angle glaucoma?

A

Normal: 0.4-0.7

> 0.7 in open angle glaucoma

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11
Q

How is open angle glaucoma diagnosed?

A

Tonometry to measure IOP
Central corneal thickness measurement
Gonioscopy to assess peripheral anterior chamber configuration and depth
Visual field measurement
Slit lamp with pupil dilation to assess optic nerve and fundus

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12
Q

How is open angle glaucoma treated?

A

Drugs:
Prostaglandin analogues (latanoprost) - increase uveoscleral outflow
Beta blockers (timolol) - reduce aqueous production
Alpha agonists (brimonidine) reduce aqueous and increase uveoscleral outflow
Carbonic anhydrase inhibitors (acetazolamide) reduce production of aqueous
Miotics (pilocarpine) reduce resistance to aqueous outflow
Laser therapy (trabeculoplasty)
Surgery

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13
Q

What is acute closed angle glaucoma?

A

A form of glaucoma where the angle of the anterior chamber narrows acutely causing a sudden rise in intraocular pressure to more than 30mmHg

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14
Q

What features are associated with acute closed angle glaucoma?

A

Severe pain - ocular or headache
Decreased visual acuity
Hard eye
Red eye
Haloes around light and blurring of vision due to corneal oedema
Semi dilated non reacting pupil, often oval shaped
Systemic upset - nausea, vomiting, abdo pain

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15
Q

What can make acute closed angle glaucoma worse?

A

Mydriasis e.g watching TV in dark room, eye patches

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16
Q

Primary acute closed angle glaucoma occurs in patients with an …

A

Anatomical predisposition

17
Q

Secondary acute closed angle glaucoma occurs from pathological processes such as..

A

Traumatic haemorrhage pushing posterior chamber forwards

18
Q

What is the peak incidence for acute closed angle glaucoma?

A

40-60

19
Q

Is the rise in IOP in ACAG rapid or gradual?

A

Rapid

20
Q

Is acute closed angle glaucoma an emergency?

A

Yes requires rapid recognition and management as irreverent sight loss can occur in a few hours

21
Q

How should acute closed angle glaucoma be managed?

A

Send for gonioscopy
Start triad of: beta blockers to suppress aqueous production, pilocarpine (miosis opens a closed drainage angle) and IV acetazolamide to reduce aqueous formation
Analgesia
Antiemetics
Admit to monitor IOP
Peripheral iridectomy (laser or surgery) once IOP controlled - piece of iris removed in both eyes to allow aqueous to flow

22
Q

If increased IOP is detected, what type of follow up is required?

A

Life long

23
Q

Describe tonometry

A

Eye numbed with eye drop anaesthesia
Tonometer pressed against eye
Force with which the eye pushes back use to estimate pressure in eye

24
Q

Define glaucoma

A

Optic neuropathy with death of many retinal ganglion cells and their optic nerve axons. IOP may be raised, but this is not part of the definition

25
Q

What side effects can prostaglandin analogues have?

A

Brown pigmentation on iris
Increase eyelash length
Periocular skin pigmentation
Red eye

26
Q

Beta blockers should be avoided in those with..

A

Asthma

Heart block

Ophthalmology (25 decks)

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