Glaucoma

Question 1

Triad for Glaucoma

Answer 1

Raised IOP
Visual field defects- peripheral loss
Optic disc changes

Question 2

What signs of primary open angle glaucoma are seen on fundoscopy?

Answer 2

Optic disc pallor
Optic disc cupping
Bayonetting of vessels
Cup notching, disc haemorrhages

Question 3

Two types of glaucoma

Answer 3

Open

Closed

Question 4

Position of peripheral iris in open-angle glaucoma

Answer 4

Clear of the trabecular meshwork

Question 5

Risk factors for primary open angle glaucoma

Answer 5

Age
Genetics - 16% chance if present in first degree relatives
Black patients
Myopia
Hypertension
Diabetes mellitus
Corticosteroids

Question 6

Investigations for primary open angle glaucoma

Answer 6

Assess visual fields
Slit lamp with pupil dilatation to assess optic nerve and fundus
Applanation tonometry - measure IOP
Central corneal thickness measurment
Gonioscopy
Assess risk of future visual impairment - central corneal thickness, IOP, family history, life expectancy

Question 7

First line Treatment for Primary Open Angle Glaucoma

Answer 7

First line - prostaglandin analogue drops

Question 8

Second line treatment for Primary Open Angle Glaucoma

Answer 8

Beta blocker, carbonic anhydrase inhibitor or sympathomimetic eye drops

Question 9

Advanced treatment for Primary Open Angle Glaucoma

Answer 9

Surgery

Laser

Question 10

Example of prostaglandin analogue

Answer 10

Latanoprost

Question 11

Mode of action of prostaglandin analogue

Answer 11

Increases uveoscleral outflow

Question 12

Adverse effects of prostaglandin analogue

Answer 12

Brown pigmentation of iris

Increased eyelash length

Question 13

Example of beta blocker used in Primary Open Angle Glaucoma

Answer 13

Timolol, betaxolol

Question 14

Mode of action of beta blocker in POA Glaucoma

Answer 14

Reduces aqueous production

Question 15

In which conditions should a beta blocker be avoided in POA Glaucoma?

Answer 15

Asthma

Heart block

Question 16

Example of sympathomimetic for POA glaucoma and mode of action

Answer 16

Brimonidine

Reduces aqueous production, increases outflow

Question 17

Adverse effect of sympathomimetic

Answer 17

Hyperaemia

Question 18

A sympathomimetic in treatment of POA glaucoma should be avoided when taking which medications?

Answer 18

MAOI or tricyclic antidepressants

Question 19

Exmaple of carbonic anhydrase inhibitor for POA glaucoma

Answer 19

Dorzolamide

Question 20

Mode of action of dorzolamide

Answer 20

Reduces aqueous production

Question 21

Example of a miotic and mode of action

Answer 21

Pilocarpine

Increase uveoscleral outflow

Question 22

Adverse effects of miotics

Answer 22

Constricted pupil
Headache
Blurred vision

Question 23

Factors predisposing to Acute Angle closure Glaucoma

Answer 23

Hypermetropia
Pupillary dilatation
Lens growth associated with age

Question 24

Features of Acute Angle Closure Glaucoma

Answer 24

Severe pain - ocular or headache
Decreased visual acuity
Symptoms worse with mydriasis
Hard, red eye
Haloes around light
Semi-dilated non-reacting pupil
Corneal oedema - dull or hazy cornea
Systemic upset - nausea, vomiting

Question 25

Management of Acute Angle Closure Glaucoma

Answer 25

Refer to ophthalmologist
Reduce aqueous secretion with acetazolamide
Induce pupillary constriction with topical pilocarpine

Question 26

Which congenital infection is associated with glaucoma and cataracts?

Answer 26

Rubella

Question 27

Glaucoma and cataracts can occur as side effects of which drugs?

Answer 27

Glucocorticoids