Glaucoma

Question 1

Define:

Answer 1

• Optic neuropathy with typical field defect usually associated with ocular hypertension (intra-ocular pressure > 21 mm Hg)

Question 2

Primary causes:

Answer 2

o Acute closed-angle glaucoma (ACAG)
o Chronic closed-angle glaucoma
o Primary open-angle glaucoma (POAG)

Question 3

Secondary causes:

Answer 3

o Trauma
o Uveitis
o Steroids
o Rubeosis iridis (formation of new blood vessels on the surface of the iris) - image

Question 4

Congenital causes:

Answer 4

o Buphthalmos (enlargement of the eye balls)

Question 5

Epidemiology:

Answer 5

• Prevalence:
o 1% in over 40 yrs
o 10% in over 80 yrs
• 3rd most common cause of blindness worldwide

Question 6

Symptoms of acute closed angle:

Answer 6

o Painful red eye
o Vomiting
o Impaired vision
o Haloes seen around lights

Question 7

Symptoms of primary open angle:

Answer 7

o Usually ASYMPTOMATIC

o Peripheral visual field loss

Question 8

Symptoms of congenital:

Answer 8

o Buphthalmos
o Watering
o Cloudy cornea

Question 9

Signs of acute closed angle:

Answer 9

o	Red eye 
o	Hazy cornea 
o	Loss of red reflex 
o	Fixed and dilated pupil
o	Eye is tender and hard on palpation 
o	Cupper optic disc 
o	Visual field defect 
o	Moderated raised intra-ocular pressure

Question 10

Signs of primary open angle:

Answer 10

o Optic disc may be cupped

o Usually NO signs

Question 11

Investigations:

Answer 11

•	Goldmann Applanation Tonometry
o	Standard method of measuring intra-ocular pressure 
o	Normal IOP = 15 mm Hg 
•	Visual field testing
•	Pachymetry
o	Using ultrasound or optical scanning to measure central corneal thickness (CCT)
o	CCT < 590 mm = higher risk of glaucoma
•	Fundoscopy
o	Detects pathologically cupped optic disc 
•	Gonioscopy
o	Assess iridocorneal angle 
•	Perimetry (Visual Field Testing)