Glaucoma disease Flashcards
What is the most common type of open angle glaucoma?
POAG
NOTE: asymptomatic until later stages (periph/central VA loss)
Signs of POAG?
- ONH damage
- Large C/D
- Asymmetry > 0.2
- Focal vergical thinning/notching
- NFL bundle defects
- Vascular signs (baring, hemes)
- Doesn’y follow ISNT
- IOP >21 mmHg
What is the most common VF defect in POAG?
Nasal step
Which open angle glaucoma are DH more likely to be seen in?
NTG
What are you thinking about systemically in NTG? What do you need to R/O?
Raynaud’s, migraines, low BP, sleep apnea, hypercoagulability
R/O hemorrhagic shock, MI, syphilis, vasculitis, especially if unilateral
What VF defect are you expecting in NTG?
More focal/dense+close to fixation
Inferotemporal rim is MORE commonly affected first compared to POAG
What are some RF for POAG?
- Thin corneas <555 um
- AA
- Family Hx
- Older age
What are RF for NTG?
- Japanese
- Female
- IOP <21 mmHg
- Drance Hemes
Old age, Scandinavian, Caucasian, & bull’s eye on the lens capsule –> what should you think?
Pseudoexfoliation (PXE) Glaucoma
What are common findings in PXE glaucoma?
- Abnormal white flaky deposits on pupil margin
- Lens capsule (bull’s eye)
- Zonules
- +TM
- Poor pupil dilation
- INC risk of lens subluxation
- Cataract Sx complications
- Sampaolesi’s line
What is the risk of developing glaucoma in PXE?
15% in 10 years
You see a young, myopic male who is caucasian with posterior bowing of the iris. What glaucoma should you be thinking about?
Pigmentary Dispersion Syndrome
Common signs of PDS?
- Bilateral
- Bowing of iris posteriorly = contact bw iris/lens zonules
- Asymptomatic but may have blur/halos after exercising/pupil dilation
- TID, Krukenberg’s spindle, TM hyperpigmentation, Sampolesi’s line****
Risk of developing glaucoma in PXE and PDS in 10-15 years?
15%!
Name the types of primary angle closures?
- Acute
- Sub-acute (chronic)
- Pupillary block (iris bombe)
- Plateau iris syndrome
Common signs in Acute Angle Closure?
- > 50 mmHg (acute)
- Halos
- Vomiting
- Intense ocular pain
- Hazy cornea
- Mid dilated pupil
- Ciliary flush
- Glaukomflecken (anterior subcapsular opacities)
What is the biggest threat to vision in an acute angle closure?
Acute CRAO (IOP > perfusion pressure of CRA)
What are some signs of sub-acute (chronic) angle closure?
- PAS/pigment clumps on TM
- Progressive optic nerve damage w corresponding VF loss
NOTE: in pts w occludable angles
When is pupillary block (iris bombe) most likely to occur?
With anatomically narrow angles (hyperopes)
MOST risk = mid-dilated (greatest iris-lens contact)
What are the risk factors for pupillary block?
- Hyperopia
- Advanced cataracts
- Asian/inuit
- Subluxation of the lens
When is neovascular glaucoma most commonly seen?
As a result of retinal ischemia
- CRVO (MOST COMMONLY)
- Proliferative retinopathy (2nd)
NEXT: ocular ischemic syndrome, CRAO, retinal detachments = much less common
Most important sign of neovascular glaucoma?
Rubeosis of the iris!!!!
Progression can cause 2nd angle closure –> 360 degrees of PS causes pupillary block, resulting in angle closure. PAS causes varying changes in IOP (greater the degree of PAS, greater the elevation of IOP)
What causes uveitic glaucoma?
Due to PAS + PS**
Uveitis causes iris to becomes inflamed + sticky can cause stick to the lens or TM
PS and cause of pupillary block if 360 of attachment btwn iris/lens, PAS cause varying changes in IOP
Which migraine medication can cause acute angle closure?
Topamax (Topiramate)
Causes supraciliary effusion (moves lens/iris forward), occurs w/in 1st month of use OR if dosage INC
Congenital glaucoma is a developmental abnormality in AC impeding aqueous outflow. Describe the patient profile.
- Birth to 3 months
- Males
- Bilateral
- Bupthalmos: enlarge HVID >12mm that occurs by 1 year old in pts w congenital glaucoma as a result of high IOP
What syndrome that causes glaucoma is characterized by endothelium that takes on epithelial characteristics?
Iridocorneal endothelial (ICE) syndromes
What are 3 things that can occur in ICE syndromes?
- Essential iris atrophy: iris thinning=heterochromia, polycoria, corectopia, ectropion uveae
- Chandler’s syndrome: corneal endothelium has “beaten metal” appearance + corneal edema + corectopia
- Cogan-Reese (Iris nevus) Syndrome: nodules present on anterior iris surface
Which Axenfeld Rieger Syndrome has Schwalbe’s Line anteriorly displaced?
Posterior Embryotoxin
Which Axenfeld Rieger Syndrome has Schwalbe’s Line + Angle abnormalities?
Axenfeld anomaly
Which Axenfeld anomaly Schwalbe’s Line + Angle abnormalities + Iris stromal hypoplasia?
Rieger’s anomaly
Which Axenfeld anomaly Schwalbe’s Line + Angle abnormalities + Iris stromal hypoplasia + SYSTEMIC DEFORMITIES?
Rieger’s syndrome
