Gluacoma

Question 1

Describe pathophys of Glaucoma

Answer 1

Increased adherence of the iris to the lens decreases the flow of aqueous humour from the ciliary body to the canal of Schlemm at the limbus

• precipitated by pupillary dilation
• increased pressure causes perpetuation of the problem causing
• —accumulation of aqueous humour in the posterior chamber
• —bulging of the iris forwards

THe above leads to rapid and severe elevation in IOP - pop mean IOP is between 10-21 but in APAC can rise to >60mmhg

Question 2

Discuss risk factors for the development of ACAC glaucoma and precipitants

Answer 2

RISK FACTORS

• Advancing age
• shallow anterior chamber
• increased lens thickness
• family history
• certain ethnic backgrounds (south east asians (esp china)
• females
• myopic

PRECIPITANTS

• drugs with anticholinergic actions
• beta agonists
• mydiatics
• emotional upset
• low lighting

Question 3

Discuss clinical features

Answer 3

History

• severe unilateral pain
• may start after watching movies or TV or lying face down
• nausea and vomiting
• poor vision - can be preceded by halos around lights

Examination

• mid dilated non reactive pupil - suggest pressure of >40mmhg
• shallow anterior chamber
• corneal haze
• marked increased IOP
• RAPD

Question 4

Discuss management

Answer 4

Drug - affective in 50% of cases

• acetazolamide 500mg IV stat than 250mg tds
• pilocarpine 2% every 5 minutes for 1 hour
• timolol 0.5% 1 drop every 30-60 minutes
• apraclonidine
• opiates

SURGERY
-definitve