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Opthalmology > Glaucoma > Flashcards

Glaucoma Flashcards

1
Q

what produces aqueous fluid

A

ciliary bodies

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2
Q

where is aqueous fluid secreted + how

A

posterior chamber, 50% diffusion, 50% active secretion

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3
Q

how does aqueous fluid drain from the anterior chamber

A

via trabecular meshwork, into the canals of schlemm, then to the collecting channels into the venous system

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4
Q

what is aqueous used for

A

maintain IOP for eye shape, as well as providing nutrition to the cornea and removing waste

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5
Q

what is the average IOP

A

15.5

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6
Q

whats the normal range of IOP

A

10-21 mmHg

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7
Q

what is progressive open angle glaucoma

A

chronic increase in IOP leading to a loss of retina/nerve fibres + optic disc cupping, causing peripheral vision loss which may progress to total blindness

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8
Q

what is the most common type of glaucoma

A

progressive open angle glaucoma

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9
Q

what are risk factors of progressive open angle glaucoma

A 
increased intraocular pressure
FHx (most important) 
myopia
afrocaribbean 
diabetes `
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10
Q

what % of people >40 and >75 have progressive open angle glaucoma

A

1% >40 ,5% >75

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11
Q

what is seen on fundoscopy when looking at an eye with progressive open angle glaucoma

A

optic disc atrophy (border blurring)

cupping (increased cup to disc ratio)

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12
Q

what is acute angle closure glaucoma

A

acute increased pressure causing pain, blurred vision , corneal odema, red eye and a fixed, mid-dilated pupil

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13
Q

what is the pathology of acute angle closure glaucoma

A

lens increases with age and pushes iris closer to the trabecular meshwork, at a critical point the iris blocks off the drainage causing a blockage and rapid rise in intraocular pressure

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14
Q

why may acute angle closure glaucoma be helped by going to bed

A

causes the pupil to constrict, causing iris to be pulled away from sides of eye, decreasing the blockage and allowing drainage - this means symptoms may be present for weeks before a full attack occurs

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15
Q

why may acute angle closure glaucoma be helped by going to bed

A

causes the pupil to constrict, causing iris to be pulled away from sides of eye, decreasing the blockage and allowing drainage - this means symptoms may be present for weeks before a full attack occurs

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16
Q

how do you treat acute angle closure glaucoma

A

pilocarpine/acetazolamide to shrink pupil

IV Diamox and mannitol

BILATERAL laser iridotomy or trabeculotomy allows drainage - bilateral = preventative

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17
Q

what is rubeotic glaucoma

A

complication of central retinal vein occlusion or diabetic retinopathy, where neovascularisation near the iris causes occlusion of the trabecular network causing rapid increase in IOP

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18
Q

what are the symptoms of rubeotic glaucoma

A 
pain
decreased VA
red eye
corneal odema 
rubeosis (neovascularisation of the iris - looks like a red ring) 
pupil distortion
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19
Q

how does each untreated IOP over the threshold relate to prognosis for vision

A

IOP >30 = blind in 3 years
IOP 25-30 = blind in 6 years
IOP 21-25 = blind in 15 years

20
Q

how are visual fields mapped + which is more common now

A

Goldmann perimetry or automated perimetry (automated more common now)

21
Q

how does goldmann perimetry work

A

hollow white bowl is placed in front of patient and lights of varying size and intensity are presented and the patient must say if they can see it

these are then mapped on a diagram

22
Q

how does automated perimetry work

A

similar to goldmann perimetery i that they look at a blank screen with a light on it but the machine moves the lights automatically and the machine has a button to press when the light is seen, this then automatically maps the visual field

23
Q

what eye drops are available for glaucoma treatment

A 
prostaglandin analogues  - latenoprost
beta blockers 
carbonic anhydrase inhibitors - dozolamide 
alpha-agonists - brimonidine
cholinergic - pilocarpine
24
Q

which medical treatments for glaucoma cause decreased aqueous production

A

beta blockers
carbonic anhydrase inhibitors
alpha-agonists (partially)

25
Q

what medical treatments for glaucoma cause increased aqueous outflow

A

cholinergics
prostaglandin analogues
alpha-agonists (partially)

26
Q

what medical treatment for glaucoma can be given in tablet form

A

carbonic anhydrase inhibitors

27
Q

what are the surgical options for glaucoma treatment

A

trabeculoplasty
trabeculotomy
iridotomy

28
Q

what is a trabeculoplasty

A

50-100 shots delivered by a laser to trabecular meshwork to increase drainage

29
Q

what type of glaucoma is trabeculoplasty limited to

A

open angle

30
Q

what is a trabeculectomy

A

controlled fistula created where aqueous leaks out under conjunctiva

31
Q

what is the success rate for trabeculectomy

A

50-90%

32
Q

what are risk factors for failure for trabeculectomy

A 
previous surgery 
Afro-Caribbean 
long term topical meds - especially pilocarpine
co-existing uveitis 
diabetes
33
Q

what are side effects of alpha blockers

A

dizziness
syncope
allergy

34
Q

what are side effects of prostaglandin analogues

A

lash growth

pigmentation (usually of iris)

35
Q

what are side effects of cholinergics

A

eye ache
headache
dim vision

36
Q

what are side effects of carbonic anhydrase inhibitors

A

taste problem

acidosis

37
Q

what kind of eye drops cause the least discomfort

A

preservative free

38
Q

what are some new surgical techniques trialed for glaucoma

A

laser suture lysis
miucrotrabeculotomy
phacotrabeculotomy

39
Q

what is the definition of ocular hypertension

A

increased IOP but no damage and full visual fields

40
Q

how may people with ocular hypertension progress to glaucoma

A

1%

41
Q

what is the normal value of the cup:disc ratio

A

< or equal to 0.4 (although this is contested)

42
Q

if the inferior portion of the retina is damaged, what part of vision will be affected

A

the superior aspect

43
Q

what treatment is 1st line for open angle glaucoma

A

prostaglandin inhibitors

44
Q

what does IV mannitol do

A

shrinks vitreous, as it is an osmotic agent

45
Q

why does an IOP >45 mean that eye drops are contraindicated

A

45 is the perfusion pressure of the retinal artery, so eye drops won’t be distributed if used with an IOP >45

46
Q

what drugs are risk factors for causing acute glaucoma

A

nebulised ipratropium bromide
TCAs
anitmuscarinics

Opthalmology (16 decks)

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