glaucoma LGW Flashcards
what are the differential diagnosis of cloudy cornea in peds ?
birth trauma
rubella keratitis
metabolic disorders
Congenital hereditary endothelial dystrophy.
Sclerocornea
what are the differential diagnosis for large cornea in peds ?
megalo-cornea
high myopia
what are the differential diagnosis for epiphora in peds ?
nasolacrimal duct ectasia
lacrimation secondary to occular irritation
congenital glaucoma
what are the types of congenital glaucoma ?
primary
secondary ( due to systemic disease or occular disease)
what are the types of congenital primary glaucoma ?
true
juvenile
infantile
which primary congenital glaucoma type is the most common ?
infantile glaucoma
what aree the features of
true
infantile
juvenile
true - IOP raised in intra uterine life
infantile - manifests before the age of 3
juvenile - the rarest manifests betweeen thee age of 3 and 16
what is the cause of primary congenital glaucoma ?
trabeculodysgenesis
what is the presentation of congenital primary glaucoma ?
Axial myopia
Buphthalmous
Corneal haze
Diameter of cornea
Descement membrane breaks
Disc cupping
Epiphora
what is thee other term used to describe descement memb breaks ?
haat striae
what is thee normal IOP in children ?
10-12 mmhg
what does buphthalmous mean ?
large eyes as a result of stretching the sclera due to elevated IOP that happened in intra-uterine life
it appears blue due to underlying uvea
what investigations should be donee for cases of suspected congenital glaucoma ?
corneal diameter measurement
tonopen
gonioscopy
what corneal measurement raises suspicion for congenital glaucoma ?
more than 12 before the age of 1
what is the mode of inheritance of congenital glaucoma ?
usually sporadic
but can be autosomal recessive
what does the prognosis depend on ?
age of onset and seeverity
what is the definitive treatment for congenital glaucoma ?
goniotomy
trabeculotomy
Amblyopia and refractive error should be corrected
what if goniotomy cant be performed due to corneal haze ?
perform trabeculotomy
what tools are used to measure IOP ?
- goldmann tonometry
- portable applanation -perkin - more portable
- electronic-indentation- tono-pen - can be used with soft contact lens and corneal oedema
- re-bound tonometry - uswd for screening
whiich tool can be useed for screening purposes of measuring IOP ?
re bound tonometry
what method does a gonioscopy use to visualize ?
total internal reflection to visualize the anterior chamber angle
how can early stage glaucomatous damage be suspected or seen ?
using Ganglion cell complex (GCC) analysis
what are the combination therapies for glaucoma ?
Xalacom, Cosopt, Combigan.
what are the indications for a trabeculectomy ?
1- Failure of conservative therapy to achieve adequate
IOP control
2- Progressive deterioration despite seemingly
adequate IOP control (including poor adherence to
the recommended medical regimen)
3- Primary therapy. Advanced disease requiring a very
low target pressure may achieve a superior longterm outcome from early surgery, particularly in
younger patients.
4- Patient preference.
what is the effect of anti-metabolites on filtration surgery ?
increase survival time of filtration surgeries by preventing bleb fibrosis and scarring.
what are examples of anti-metabolites used in filtration surgery ?
mitomycin c
5- FU
a higher risk patient would use mitomycin rather than 5-FU
why is the pupil fixed and mid-dilated in glaucoma ?
due to ischemia of the sphincter pupillae
what are the contraindications to carbonic anhydrase inhibitors ?
sulfonamide allergy
what type of drug is pilocarpine ?
miotic , increases uveoscleral flow and is used in the management of acute angle closure glaucoma
what is the definitive treatment for angle closure glaucoma ?
- Peripheral Laser iridotomy
- Lens extraction
- Guarded filtration procedure
(surgical trabeculectomy/iridectomy)
in angle closure glaucoma - what to do with the fellow eye ?
bilateral peripheral laser iridotomy
