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Ocular Disease II > Glaucoma: Anterior Chamber Evaluation > Flashcards

Glaucoma: Anterior Chamber Evaluation Flashcards

1
Q

What 3 things regulate IOP?

A
  1. Aq Humor Production
  2. Resistance to Aq. Humor Outflow
  3. Episcleral Venous Pressure
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2
Q

Anatomy: Ciliary Body

  1. 2 Regions: What are they?
A
  1. Pars Plicata
    a. Ciliary Processes
  2. Pars Plana
    a. Transition b/w Ciliary Body and Choroid (Terminates at ORA SERRATA)
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3
Q

Anatomy: Ciliary Body

  1. Ciliary Stroma
    a. Highly Vascular; Loose Connective Tissue; It Lies b/w what 2 things? (FORMS what)
    b. Spaces b/w them form the PATHWAY for what?

c. What does it CONTAIN?

A
  1. a. Muscle and Epithelial Layers (forms CORE of Ciliary Processes)
    b. for Uveoscleral Outflow
    c. MACI (Capillaries that are Large and FENESTRATED)
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4
Q

Anatomy: Ciliary Body: Ciliary Epithelium

  1. Non-Pigmented: Which layer?
    a. Continuous Anteriorly with?
    b. Posteriorly with?
    c. SIte of what 2 things?
  2. Pigmented: Which layer?
    a. Continuous Anteriorly with what?
    b. Posteriorly with what?
A
  1. Inner Layer
    a. Posterior Iris Epithelium
    b. Ora Serrata
    c. ACTIVE SECRETION of Aq. Humor and Site of Diffusion Barrier b/w Blood and Aqueous
  2. Outer Layer
    a. Iris Epithelium
    b. RPE
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5
Q

Anatomy: Ciliary Body: Aq. Humor Production

  1. Diffusion (Passive)
  2. Ultrafiltration (Passive)
  3. These are the ways substances leave blood; but they HAVE to be ACTIVELY SECRETED across what in order to become AQUEOUS?
A
  1. passive movement of ions across membrane related to SIZE and SOLUBILITY (Small, lipid soluble readily move out of FENESTRATED CAPILLARIES)
  2. Passive Flow of BLOOD PLASMA from Capillaries into the Ciliary STROMA (due to INCREASED HYDROSTATIC PRESSURE (pressure from the HEART))
  3. Across the NON-PIGMENTED CILIARY EPITHELIUM!
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6
Q

Anatomy: Ciliary Body: Aq. Humor Production

  1. Active Secretion
  2. 2 NPCE Enzymes: What are they and what do they do?
  3. So with these pumps, three things move out of the NPCE, and 1 thing moves in?
A
  1. Active transport of Larger H2O-Soluble substances or those things w/Greater charge across Cell membranes. (need ATP)
  2. NA/K ATPase: drives Na2+/K+ exchange Pump. (Yields NET OUTWARD MOVEMENT of a + charge so WATER FOLLOWS which produces Aq. Humor)
    b. Carbonic Anhydrase: Makes HCO3- from CO2 + H2O. We think that Na2+ is DEPENDENT on BICARBONATE to cross the cell membrane
  3. HCO3-, Na2+, and H2O move out; K+ moves in.
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7
Q

Anatomy: Ciliary Body: Aq. Humor Production

  1. Beta Adrenergic Receptors: What do they do?
    a. Big thing to remember is that what
  2. Alpha Receptors: What do they basically do?
A
  1. B receptors on NPCE stimulated: Affects rate of Na/K Pump
    a. B-Agonists (B-Blockers) Lead to REDUCTIONS in Aq. INFLOW!
  2. A-2 Receptors OPPOSE B-Receptors and A-2 AGONISTS REDUCE AQ. INFLOW!
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8
Q

Aq. Outflow

  1. Trabecular Outflow
  2. Uveoscleral Outflow

Which is Pressure Dependent?

A
  1. Pressure Dependent

2. Pressure-Independent

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9
Q

Aq. Outflow

  1. TM Anatomy: What is it?
  2. What attaches to it?
A
  1. Wedge-Shaped band of tissue; Encircles and bridges the AC Angle
  2. Base: Scleral Spur
    a. OuterFace: Corneal Stroma, Sclera, Schlemm’s Canal
    b. Inner Face: Anterior Chamber
    c. Apex: Schwalbe’s Line
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10
Q

Aq. Outflow: TM Divisions

  1. Corneoscleral Meshwork
  2. Uveal Meshwork
A
  1. Outer region where sheets of TM attach to the SS

2. Inner region where sheets of TM attach to Ciliary Stroma and Longitudinal Muscle fibers

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11
Q

Gonioscopy

  1. Should be performed on whom?
    a. Can we accurately diagnose a Pt w/Glaucoma unless the anatomy of the angle has been evaluated?
    b. How often should Gonio be repeated?
    c. Clinical Pearl: GONIO should be ROUTINELY PERFORMED on which patients?
A
  1. EVERY GLAUCOMA and Glaucoma Suspect
    a. NO!
    b. Yearly for OPEN ANGLE Pts; more frequently w/Closed Angle
    c. All PHAKIC Pts w/Refractive Error >+2.50
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12
Q

Gonioscopy

  1. Flange: What does it do?
  2. Non-Flange
    a. What is it?
    b. How can it open a closed angle?
  3. What can light do?
    a. Best to perform in light or dark?
  4. Fixation: Where should patient be looking?
A
  1. Artificially opens the Angle (creates a Suction Cup Effect) –> Stretches scleral/Cornea and displaces the Iris and CB Backwards
  2. a. Dynamic/Depression Gonio
    a. Indentation w/a 4 mirror NON-FLANGE can open Closed Angles
    b. Pressure from the lens can force Aq. Into the angle and thus open it. (if no PAS there, the angle will change configuration)
  3. Don’t let it pass thru pupil causing constriction. Could make closed angle look open
    a. In BOTH
  4. Make sure Pt is looking straight ahead (no convergence)
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13
Q

Structures of the Angle

  1. Most Posterior to Anterior
A

1.Iris, CB, SS, Schlemm’s Canal (cant see unless putting too much pressure); TM (Pigmented(post) Non-pigmented(Anterior)); Schwalbe’s Line

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14
Q

Gonioscopy

  1. What STRUCTURE is CRITICAL to ASSESS for GLAUCOMA?
    a. What has to be GRADED?
A
  1. Trabecular Meshwork (Tx works here: Meds target it, and it’s a site for several SURGICAL PROCEDURES!)
    a. PIGMENT: Diagnosis of Pigmentary Glaucoma; Tx Implications
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15
Q

Secondary Glaucoma: Gonio

  1. Posterior Embryotoxin
    a. What is it?
    b. Associated with what Syndrome?
    i. If Noted, then use must RULE OUT what?
  2. What are ICEs?
A
  1. a. Prominent Schwalbe’s Line that’s DISPLACED ANTERIORLY (seen on SLE)

b. with Axenfeld’s Syndrome
i. PAS

  1. Disorders that involve PAS that may extend to Schwalbe’s Line and is associated w/Glaucoma Development
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16
Q

Secondary Glaucoma: Gonio

  1. Iris Processes
    a. What are they?
    b. Normally found in how many Peeps?
    c. Benign?
A
  1. a. Non-regressed Mesodermal Structures
    b. 1/3 normal peeps
    c. Yes. UNLESS they’re PROFUSE and CONFLUENT

*Iris –> CB or Iris –> TM

17
Q

Secondary Glaucoma: Gonio

  1. PAS
    a. What is it?
    b. 5 possible causes?
    c. Superior PAS is a DIAGNOSTIC of what?!
    d. What helps Differentiate b/w PAS and Appositional Closure?
A
  1. a. Permanent Adhesion b/w Iris –>TM or Iris –> K
    b. Angle Closure, Congenital, Inflammation, Neo, Trauma/Hyphema/Surgery
    c. CHRONIC ANGLE CLOSURE GLAUCOMA
    d. Indentation Gonioscopy (If it opens w/Indentation then it IS NOT a SYNECHIAE!
18
Q

Secondary Glaucoma: Gonio

  1. Angle Recession
    a. What is it?
    b. Angle will appear (closed or open)?
    c. Compare it to what?
    d. Traumatic Incident Usually Includes what?
A
  1. a. Tear in CB muscle layers due to Blunt or Penetrating Trauma
    b. WIDE OPEN
    c. Fellow Eye
    d. HYPHEMA
19
Q

Secondary Glaucoma: Gonio

  1. Pigmentary Glaucoma
    a. What is it?
    b. Monitor what 3 things?
  2. Pseudoexfoliation
    a. What is it?
    b. Monitor LENS for what?
A
  1. a. HIGHLY DENSE band of BROWN PIGMENT deposited on the TM in a Homogenous Fashion
    b. Cornea, Lens Capsule, and Iris for Pigmentary changes
  2. a. Systemic condition. leads to DEPOSITS of WHITE MATERIAL throughout the ANTERIOR SEGMENT!
    b. for signs of Pseudoexfoliation
20
Q

Secondary Glaucoma: Gonio

  1. Uveitic Glaucoma
    a. May have what?
  2. Neovascular Glaucoma
    a. Monitor for what 2 things?
    b. 3 Most common Etiologies?
A
  1. a. Irregular areas of Pigment deposition (angle has Dirty or Crystal Like development)
  2. a. NVA or NVI
    b. Diabetic Retinopathy; CRV Occlusion; Carotid Occlusive Disease

Ocular Disease II (15 decks)

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