Glaucoma - Acute angle closure, Primary open angle

Question 1

AACG
-pathophysiology
-presentation
-investigations
-management

Answer 1

Impaired aqueous outflow => rise in IOP
-hypermetropia (long sighted)
-pupillary dilation
-lens growth with age

Sudden reduced visual acuity
Semi dilated pupils
Hard red painful eye
Pain worse when dilation increased
Halos around light
Corneal haziness
N/V

Tonometry - high IOP
Gonioscopy - reduced angle

EMERGENCY
Initial
-direct PNS => constrict pupil to increase outflow (pilocarpine)
-Bb => decreased aqueous prod (timolol)
-A2ag => decreased aqueous prod, increase outflow (apraclonidine)
-IV acetazolamide => reduce aqueous prod

Definitive
-laser peripheral iridotomy

Question 2

POAG
-pathophysiology
-risk factors
-presentation
-investigation
-management

Answer 2

Reduced aqueous drainage
-age
-FHx
-Afro-Caribbean
-short sighted
-HTN, DM, CS use

Insidious peripheral loss => tunnel vision
Optic disc cupping
-cup:disc 0.7+
Disc pallor
Bayonetting vessels

GP referral to opthal

Perimetry - visual field
Slit lamp - fundus and optic nerve
Tonometry, gonioscopy

1st line - selective laser trabeculoplasty
2nd - prostaglandin analogues
3rd - Bb, CAinh, PNS