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Small Animal Optho/Neuro > Glaucoma Review and Managment > Flashcards

Glaucoma Review and Managment Flashcards

1
Q

What is glaucoma?

A

-Multifactorial disease
-Elevation of intraocular pressure incompatible with ocular health
-causes irreversible vision loss through optic nerve and ganglion cell death

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2
Q

Where is aqueous humor produced?

A

Ciliary Body

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3
Q

Where does aqueous humor flow after being produced by the ciliary body?

A

Through the pupil to the anterior chamber

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4
Q

Where does aqueous humor exit?

A

through the two drainage pathways

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5
Q

What physiologic dynamics have to be occurring to keep normal intraocular pressure?

A

Production of AH must equal the outflow of AH

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6
Q

What is primary glaucoma?

A

Heritable/breed related abnormality of aqueous drainage angle

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7
Q

What is secondary galucoma?

A

Numerus causes of drainage angle obstruction
-Lense luxation, uveitis, hyphemia, intraocular neoplasia, melanocytic glaucoma, pigmentary uveitis, pseudophakia/aphakia, trauma

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8
Q

What are some causes of feline glaucoma?

A

Primary: rare - Persian, Siamese and Burmese
Secondary: Similar to dogs, uveitis, aqueous humor misdirection

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9
Q

What are the mechanisms of vision loss in glaucoma?

A

High IOP
Optic Nerve Ischemia
Neurotoxic Event

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10
Q

Is glaucoma painful?

A

Yes

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11
Q

What are some clinical signs of glaucoma?

A

Acute: Blepharospasm, corneal edema, episcleral injection, dilated pupil, variable vision

Chronic: Acute possible, buphthalmos, Haabs striae (Strech), Lense subluxation, cupped optic nerve

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12
Q

How do you diagnose glaucoma?

A

Clinical signs - cloudy eye, haabs stria, fractures in desmet membrane
History and signalment - breed (basset and spaniel)
IOP measurement (tonometry) 15-25 normal - higher glaucoma
Gonioscopy (specialist)

Bupthalmus = glaucoma issue

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13
Q

What is tonometry?

A

Measure IOP
*Always do both eyes, normal is 10-25, stress can increase it *
-Acceptable methods: Rebound, applanation, indentation
-Absolute too high or disparities between the 2
(Changes through day)

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14
Q

What is tonometry used for?

A

-Primary way to diagnose glaucoma and decide therapy
-IOP varies greatly day to day
-Not helpful for early detection (not a yearly thing)

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15
Q

What is Gonioscopy?

A

-Examination of the drainage angle of the eye
-Need a special lens
- Determine likelyhood of primary glaucoma

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16
Q

What are the goals of treatment for glaucoma?

A

Maintenace of vision if possible
-buphthalmic - no visual potential (chronic)
Patient comfort
Prophylaxis in at risk eye

17
Q

What effects your management approach?

A

Etiology of glaucoma
Current IOP
Presents/Absence of vision
Stage of Disease

18
Q

What are the 3 main categories of treatment?

A

Emergency therapy
Maintenance therapy
End-stage/salvage procedure

19
Q

What classes of drugs can be used to treat glaucoma?

A

Systemic hyperosmotic medications
carbonic anhydrase inhibitors
miotics
prostaglandin analogue
B-adrenergic blocking agents

20
Q

What should you do for emergency management of glaucoma?

A

Topical Iatanoprsot (Xalatan)
-1-2 doses topically 5 min apart, rapid onset of action, convenient
-Prostaglandin analogue
-Only use if Lense not in anterior chamber

Systemic hyperosmotic medication
-IV mannitol or oral glycerin
-quick acting, short response, no use if cardiovascular issue, inferior to topical prostaglandin

21
Q

What do you treat with for maintenance of Glaucoma?

A

Carbonic Anhydrase Inhibitors (CAIs)
-most useful - effective and safe in all species
-topical and systemic available

Dorzolamide (trustopt) - TID
Brinxolamide (Azopt) - TID
-Can cause local irritation but no systemic side effect

Mitotics
prostaglandins vs other, moderatly effective, dont use in glaucoma secondary to uveitis or anterior lense lucxation, ocular side effects, good prophylaxis
-Demecarium bromide BID
-Pilocarpine QID

Prostaglandin Analogues
-Latanoprost (xalatan)
-Travoprost (Travatan)
-Bimatoprost (lumigan)
(not helpful in cat)

B-Blockers (topical)
-Mild/moderate effect, not enough as sole agent, prophylaxis, bradycardia and harm asthma
-Timolol maleate
-Betaxolol

Combo drugs
-Dorzolamide-timolol (cosopt)

22
Q

Which glaucoma medication class is not useful in cats?

A

Prostaglandin Analoguse

23
Q

Which glaucoma treatment is safe and effective for all species?

A

Carbonic Anydrase Inhibitors

24
Q

Which drug class should you avoid in glaucoma secondary to uveitis or anterior lens luxaiton?

A

Miotics

25
Q

Which drug class should be avoided in bradycardia or may worsen asthma?

A

B- Blockers

26
Q

What are the general treatment principles for glaucoma?

A

-Treat aggressively early
-Don’t taper medications in apparently well controlled cases
-Consider surgical intervention if possible in early in disease

27
Q

How should you follow up with your glaucoma case?

A

Daily/weekly recheck until IOP control established
-Recheck 3-4 weeks after
-Check IOP every 4-6 weeks in eye at risk of glaucoma
-Owner education and observation critical

28
Q

What is the target IOP for glaucoma patients?

A

Dont even want a high normal
<15-20mmHg ideal
(IOP fluxuates so don’t rely on IOP reading)

29
Q

What medications should you administer for medical prophylaxis?

A

-Delay in onset of primary glaucoma in second eye
-medications- topical miotitc benefit, CAI and B-blocker, adjunctive topical corticosteroids

30
Q

What other medical treatment considerations should be taken?

A

Manage concurrent ocular disease
Topical mydriatics (atropine) are contraindicated - dont dilate the eye when high pressure

31
Q

What can be done surgically to manage glaucoma?

A

Decrease Aqueous Production
-Cyclodestructive procedure
-Cyclophotocoagulation
-Cyclocryotherphy

Increase aqueous outflow - shunt/gonioimplants

Combination procedure

32
Q

What is the prognosis for glaucoma?

A

Long-term visual prognosis is poor
- go blind in several months, surgical intervention prolongs vision but doesn’t cure it

Salvage surgical procedures - irreversibly blin eyes

33
Q

What are some salvage procedures that could be performed?

A

Enucleation, Evisceration/intrascleral prothesis
Chemical ciliary body ablation

34
Q

What drug is used for chemical ciliary body ablation?

A

Intravitreal gentamicin injection with steroid (blind eye only, avoid Lense puncture, outcome unpredictable)

Small Animal Optho/Neuro (13 decks)

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