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Ocular Block 8 > Glaucoma Qs And As > Flashcards

Glaucoma Qs And As Flashcards

1
Q

A condition of increased pressure within the eye, causing gradual loss of sight

A

Glaucoma

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2
Q

Various ways that IOP can get elevated within the eye

A
  • aqueous humor production rate
  • TM outflow interference (open vs closed)
  • pupillary block
  • plateau iris
  • pigmentation dispersions
  • neo vascularization
  • injury
  • meds
  • tumors
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3
Q

What are the different types of glaucoma

A
  • primary open angle
  • narrow angle
  • secondary
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4
Q

Where doe aqueous humor get produced

A

NPCE of the ciliary body, pars plicata

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5
Q

Where does aqueous humor go

A

From posterior chamber, through the pupils, into the anterior chamber

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6
Q

How does aqueous humor production rate affect IOP

A

Not enough, low pressure. Too much, high pressure

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7
Q

What forms the blood aqueous barrier

A

Tight junctions of NPE

Can control how much fluid goes through them

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8
Q

What happens if thi sbarrier begins to breaks down

A
  • protein from stroma get into posterior chamber, inflammatory cells
  • consequences on the pressure of the eye
  • this can increase aqueous production
  • gate keepers broken down so everything can get out and back in
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9
Q

If the anatomical angle is wide open, could there still be an issue with TM outflow

A

Yes from pigmentary dispersion

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10
Q

How can the TM outflow be affected if the angle is open

A
  • pigmentation dispersion
  • plaque in JCT
  • Synchiea
  • proteins that get through a broken down tight junction of ciliary body
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11
Q

How would we treat a blocked angle

A
  • shunts/blebs

- Laser trabeculoplasty (shrinks tissue and increases outflow)

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12
Q

Increased resistance to flow of aqueous humor through the pupil from the posterior to anterior chamber, this leads to an anterior bowing of the peripheral iris over the TM and it causes the angle to close

A

Pupillary block

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13
Q

What is the normal iris to lens relationship in the eye

A

Iris is anterior to the lens and touches it with the lens on its posterior side (of iris), acts as a one way valve to allow fluid to get out of the posterior chamber, but not back in

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14
Q

What is the normal flow of aqueous through this relationship of lens and iris

A

-iris acts as a one way valve that allows the aqueous to flow in one direction from posterior to anterior, and prevents it from flowing back into the posteiror chamber

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15
Q

Where does the pupillary block occur

A

Pupil gets pushed against the lens, block the flow from posterior chamber causing a buildup of pressure in the posterior chamber, and causing the angle to get narrow or close

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16
Q

How will pupillary block affect the iris morphology

A

Iris can get stuck with inflammation sticky stuff and can cause the iris to stick to the anterior surface of the lens and fluid cannot pass through it anymore

  • iris will bulge anteriorly
  • middle to peripheral part of iris bows
17
Q

How does pupillary block affect aqueous flow in the posterior and anterior chamber

A

Aqueous gets stuck in the posteiror chamber, causes IOP to rise, and angle to close/get narrow
-pressure goes up

18
Q

How do you treat pupillary block

A

Laser peripheral iridotomy

19
Q

One of the most common angle closure glaucomas presenting in young patients. Closing of the anterior chamber angle secondary to a large or anteriorly positioned ciliary body that mechanically alters the postion of the peripheral iris in relation to the TM

A

Plateau iris

20
Q

Which is acquired, pupillary block or plateau iris

A

Pupillary block

21
Q

Which are you born with, pupillary block, plateau iris

A

Plateau iris

22
Q

The iris base in plateau iris

A

Seems to reach back and connect to ciliary body. Normally would attach laterally

23
Q

How do we treat plateau iris

A 
-pilocarpine (PNS mimetic) 
Peripheral iridotomy (more as a prophylactic measure
24
Q

Affliction of the eye that can lead to a form of glaucoma known as pigmentary glaucoma. It takes place when the pigment cells slough off from the back of the iris and float around in the aqueous

A

Pigmentary dispersion syndrome (PDS)

25
Q

Where does the pigmentary dispersion end up and what effect does it have?

A
  • TM and it blocks the flow of aqueous
  • causes increase in IOP
  • transillumination defect (TID)
26
Q

How do you treat pigmentary dispersion

A
  • peripheral iridotomy
  • laser trabeculoplasty to shrink tissue
  • possibly use medication to lower IOP
27
Q

If you see pigment stuck to the back of the cornea

A
  • Kruckenburg spindle
  • you need to test for glaucoma
  • the pigment is from the posterior cornea
  • high risk for pigmentary glaucoma
28
Q

Does the pigment in Krukenburg spindle always orient vertical on back of cornea?

A

Convective flow of aqueous and the temperature of the aqueous being warmer in the back causing it to fall in the front
-aqueous rises along the anterior border of the iris and then falls along the cornea because it is cooler tissue

29
Q

Why is the pigment only in the center of the posterior cornea

A

Cells will gravitate to the light, pigment accumulates here, also curvature of cornea

30
Q

Medical condition of the iris which new abnormal blood vessels are found on the surface of the iris

A

Neovascularization of the iris (NVI) or Rubeosis iridis

31
Q

What causes NVI

A

Lack of oxygen

  • blocked blood vessel (CRA)
  • diabetes
32
Q

What complications can arise from NVI

A
  • leaking of fluid into the anterior and posterior chamber
  • increased IOP
  • blood vessels could grow into the angle too, narrow the angle
33
Q

Treatment for NVI

A
  • AntiVEGF
  • steroids
  • laser
34
Q

Perfusion theory of increased IOP

A
  • the higher the pressure, the Ig her the gradient the blood has to get into the eye and the nerve
  • measure ocular perfusion pressure
  • the higher the gradient, the bigger the problem
  • causes slow ischemia over time
35
Q

Physical damage from increased IOP

A

High pressure crimping the nerves as they bend at 90 degrees

Ocular Block 8 (6 decks)

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