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Duke Elder > Glaucoma > Flashcards

Glaucoma Flashcards

1
Q

which part of the ciliary body produces aqueous humour?

A

pars plicata

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2
Q

Which branch of the ANS controls aqueous humour production?

A

sympathetic

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3
Q

Which adrenoceptors increase aqueous secretion?

A

beta 2

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4
Q

Which adrenoceptors decrease aqueous secretion?

A

alpha 2

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5
Q

Is IOP higher in the mornings or evenings?

A

mornings

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6
Q

What is the most common outflow route for aqueous?

A

trabecular outflow through the meshwork and canal of Schlemm to the episcleral veins

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7
Q

What is the less common outflow route for aqueous?

A

uveoscleral outflow through the ciliary muscle to the suprachoroidal space then drained by choroidal veins

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8
Q

How does the conc of glucose, proteins and ascorbate in aqueous compare to the serum?

A

less glucose and proteins

more ascorbate

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9
Q

By what mechanism is most aqueous secreted by the pars plicata?

A

via Na/K transporters

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10
Q

What are the three mechanisms by which aqueous is secreted by the pars plicata?

A

Na/K transporters
ultrafiltration
osmosis

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11
Q

What are the 5 layers of the ciliary body?

A 
lamina
stroma
pigment epithelium
non-pigment epithelium 
endothelium
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12
Q

Which layer of the trabecular meshwork has the highest resistance and is removed to decrease IOP?

A

juxtacircular tissue

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13
Q

Name the structures seen on gonioscopy from ant to post when the iridocorneal angle is open?

A 
Schwalbe's line
non-pigmented epithelium
pigmented epithelium 
scleral spur
ciliary body band 
iris
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14
Q

What term describes the iris adhering to more anterior structures as a result of inflammation?

A

peripheral anterior synechiae

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15
Q

What term describes the iris adhering to the lens as a result of inflammation?

A

posterior synechiae

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16
Q

What is normal intraocular pressure?

A

10-21

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17
Q

What is ocular hypertension?

A

IOP >21 with no glaucomatous changes

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18
Q

What were the findings of the ocular hypertension treatment study?

A

9.5% of patients with OHT converted to open angle glaucoma in 50 years. If you reduce IOP by 20% risk falls to 4.4.%

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19
Q

What are the risk factors for conversion of OHT to open angle glaucoma?

A

older ages
IOP >25.75
large cup to disc ration
thinner CCT

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20
Q

What is primary open angle glaucoma?

A

Visual field defect, open angle and IOP >21

21
Q

What changes are seen on fundoscopy in primary open angle glaucoma?

A

high cup to disc ratio and thinning of neuro retinal rim

22
Q

What investigation measures central corneal thickness?

A

pachymetry

23
Q

What are the two most common initial visual field defects associated with glaucoma?

A

nasal step

temporal wedge

24
Q

What conditions are associated with normal tension glaucoma?

A

Raynauds, migraines and hypotension

25
What is the risk of progression of visual field defects at 5 years if normal tension glaucoma goes untreated?
50%
26
What drugs are used in the treatment of normal tension glaucoma?
prostaglandin analogues
27
By what mechanism do PGAs lower IOP?
increased uveoscleral outflow
28
By what mechanism do beta blockers, carbonic anhydrase inhibitors and alpha agonists lower IOP?
decreased aqueous production
29
What are the features of primary angle closure suspects (PACS)?
narrow angle, no peripheral anterior synechiae
30
What are the features of primary angle closure (PAC)?
peripheral anterior synechiae and elevated IOP but no glaucomatous optic nerve changes
31
What are the features of primary angle closure glaucoma (PACG)?
peripheral anterior synechiae, raised IOP, glaucomatous changes and visual field defects
32
Risk factors for primary angle closure glaucoma
increasing age east asian hyperopia short axial length
33
Patient has sudden pain and headache while watching TV in a dark room. Describes haloes around lights and has vomited. Patient has fixed mid dilated pupil, raised IOP, corneal oedema and conjunctival hyperaemia
primary angle closure glaucoma
34
What is the acute management of primary angle closure glaucoma?
supinate patient | give systemic acetazolamide, topical beta blockers
35
What procedure should be carried out once an acute attack of primary angle closure glaucoma has resolved?
bilateral YAG laser peripheral iridotomy
36
Patient with Alzheimers presents with secondary open angle galucoma. Flaky white deposits on anterior lens capsule, sampaolesi line and peripupillary defect on slit lamp.
pseudoexfoliation syndrome
37
Myopic male presents with secondary open angle glaucoma. Blurred vision and haloes on exertion. There are mid-peripheral spoke-like defects of the iris and Krukenburg spindles in the corneal endothelium. There is pigmentation of the trabecular meshwork. AD condition.
pigment dispersion syndrome
38
Patient with proliferative diabetic retinopathy presents with painful eye. Evidence of rubeosis iridis on examination. Corneal oedema and raised IOP.
neovascular glaucoma
39
What are the management option for neovascular glaucoma?
panretinal photocoagualtion and/or anti-vegf topical steroids and atropine iop lowring agents good visual potential- glaucoma drainage device bad visual potential- cyclodiode laser
40
what drugs should NOT be used in neovascular glaucoma?
pilocarpine and prostaglandin anaogues
41
Recurrent unilateral acute attacks of raised IOP. Anterior chamber inflammation with white keratitic precipitates and mydriasis. Associated wth CMV, H. pylori and HLA BW5
Possner-Schlossman syndrome
42
What lens pathology can lead to phacolytic or phacomorphic glaucoma?
cataract
43
What is the pathogenesis of red cell glaucoma?
blunt trauma causes hyphaema which blocks trabecular meshwork
44
What is the pathogenesis of angle recession glaucoma?
rupture of ciliary body following blunt trauma
45
After how many days may a secondary bleed occur in red cell glaucoma?
3-7 days
46
What type of glaucoma can be caused by vitreous haemorrhage?
ghost cell glaucoma
47
What sort of glaucoma is associated with anterior uveitis?
Schwartz-Matsuo syndrome
48
Baby presenting with port wine stain along CNV1/V2, seizure, ipisilateral choroidal hemangiomas and secondary open angle glaucoma.
Sturge-Weber syndrome
49
Bilateral glaucoma in boys under 1 year. Epiphora, corneal oedema, photophobia and blepharospasm. Large eyes and increased corneal diameter. Haab striae.
primary congenital glaucoma

Duke Elder (8 decks)

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