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Part 1 > Glaucoma disease > Flashcards

Glaucoma disease Flashcards

1
Q

What is the most common type of open angle glaucoma?

A

POAG

NOTE: asymptomatic until later stages (periph/central VA loss)

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2
Q

Signs of POAG?

A
  1. ONH damage
  2. Large C/D
  3. Asymmetry > 0.2
  4. Focal vergical thinning/notching
  5. NFL bundle defects
  6. Vascular signs (baring, hemes)
  7. Doesn’y follow ISNT
  8. IOP >21 mmHg
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3
Q

What is the most common VF defect in POAG?

A

Nasal step

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4
Q

Which open angle glaucoma are DH more likely to be seen in?

A

NTG

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5
Q

What are you thinking about systemically in NTG? What do you need to R/O?

A

Raynaud’s, migraines, low BP, sleep apnea, hypercoagulability

R/O hemorrhagic shock, MI, syphilis, vasculitis, especially if unilateral

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6
Q

What VF defect are you expecting in NTG?

A

More focal/dense+close to fixation

Inferotemporal rim is MORE commonly affected first compared to POAG

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7
Q

What are some RF for POAG?

A
  1. Thin corneas <555 um
  2. AA
  3. Family Hx
  4. Older age
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8
Q

What are RF for NTG?

A
  1. Japanese
  2. Female
  3. IOP <21 mmHg
  4. Drance Hemes
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9
Q

Old age, Scandinavian, Caucasian, & bull’s eye on the lens capsule –> what should you think?

A

Pseudoexfoliation (PXE) Glaucoma

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10
Q

What are common findings in PXE glaucoma?

A
  1. Abnormal white flaky deposits on pupil margin
  2. Lens capsule (bull’s eye)
  3. Zonules
  4. +TM
  5. Poor pupil dilation
  6. INC risk of lens subluxation
  7. Cataract Sx complications
  8. Sampaolesi’s line
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11
Q

What is the risk of developing glaucoma in PXE?

A

15% in 10 years

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12
Q

You see a young, myopic male who is caucasian with posterior bowing of the iris. What glaucoma should you be thinking about?

A

Pigmentary Dispersion Syndrome

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13
Q

Common signs of PDS?

A
  1. Bilateral
  2. Bowing of iris posteriorly = contact bw iris/lens zonules
  3. Asymptomatic but may have blur/halos after exercising/pupil dilation
  4. TID, Krukenberg’s spindle, TM hyperpigmentation, Sampolesi’s line****
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14
Q

Risk of developing glaucoma in PXE and PDS in 10-15 years?

A

15%!

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15
Q

Name the types of primary angle closures?

A
  1. Acute
  2. Sub-acute (chronic)
  3. Pupillary block (iris bombe)
  4. Plateau iris syndrome
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16
Q

Common signs in Acute Angle Closure?

A
  1. > 50 mmHg (acute)
  2. Halos
  3. Vomiting
  4. Intense ocular pain
  5. Hazy cornea
  6. Mid dilated pupil
  7. Ciliary flush
  8. Glaukomflecken (anterior subcapsular opacities)
17
Q

What is the biggest threat to vision in an acute angle closure?

A

Acute CRAO (IOP > perfusion pressure of CRA)

18
Q

What are some signs of sub-acute (chronic) angle closure?

A
  1. PAS/pigment clumps on TM
  2. Progressive optic nerve damage w corresponding VF loss

NOTE: in pts w occludable angles

19
Q

When is pupillary block (iris bombe) most likely to occur?

A

With anatomically narrow angles (hyperopes)

MOST risk = mid-dilated (greatest iris-lens contact)

20
Q

What are the risk factors for pupillary block?

A
  1. Hyperopia
  2. Advanced cataracts
  3. Asian/inuit
  4. Subluxation of the lens
21
Q

When is neovascular glaucoma most commonly seen?

A

As a result of retinal ischemia

  1. CRVO (MOST COMMONLY)
  2. Proliferative retinopathy (2nd)

NEXT: ocular ischemic syndrome, CRAO, retinal detachments = much less common

22
Q

Most important sign of neovascular glaucoma?

A

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)

23
Q

What causes uveitic glaucoma?

A

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

24
Q

Which migraine medication can cause acute angle closure?

A

Topamax (Topiramate)

Causes supraciliary effusion (moves lens/iris forward), occurs w/in 1st month of use OR if dosage INC

25
Q

Congenital glaucoma is a developmental abnormality in AC impeding aqueous outflow. Describe the patient profile.

A
  1. Birth to 3 months
  2. Males
  3. Bilateral
  4. Bupthalmos: enlarge HVID >12mm that occurs by 1 year old in pts w congenital glaucoma as a result of high IOP
26
Q

What syndrome that causes glaucoma is characterized by endothelium that takes on epithelial characteristics?

A

Iridocorneal endothelial (ICE) syndromes

27
Q

What are 3 things that can occur in ICE syndromes?

A
  1. Essential iris atrophy: iris thinning=heterochromia, polycoria, corectopia, ectropion uveae
  2. Chandler’s syndrome: corneal endothelium has “beaten metal” appearance + corneal edema + corectopia
  3. Cogan-Reese (Iris nevus) Syndrome: nodules present on anterior iris surface
28
Q

Which Axenfeld Rieger Syndrome has Schwalbe’s Line anteriorly displaced?

A

Posterior Embryotoxin

29
Q

Which Axenfeld Rieger Syndrome has Schwalbe’s Line + Angle abnormalities?

A

Axenfeld anomaly

30
Q

Which Axenfeld anomaly Schwalbe’s Line + Angle abnormalities + Iris stromal hypoplasia?

A

Rieger’s anomaly

31
Q

Which Axenfeld anomaly Schwalbe’s Line + Angle abnormalities + Iris stromal hypoplasia + SYSTEMIC DEFORMITIES?

A

Rieger’s syndrome

Part 1 (31 decks)

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