Lec.9: Angle Closure Glaucoma

Question 1

which race is most likely to suffer from angle closure glaucoma?

Answer 1

chinese

Question 2

name common risk factors for angle closure glaucoma?

Answer 2

female (70% of cases), old age, hyperopia, smaller axial length, fellow eyes of an individual at risk, genetics

Question 3

what are the signs of angle closure glaucoma?

Answer 3

closed angle, elevated IOP with corresponding VF defects, iridotrabecular apposition, iridotrabecular synechiae

Question 4

name the classifications of angle closure glaucoma.

Answer 4

acute angle-closure glaucoma, sub-acute angle-closure glaucoma, chronic angle-closure glaucoma

Question 5

what are the symptoms of an acute angle-closure glaucoma?

Answer 5

ocular pain, nausea/vomiting, blurred vision, colored halos around lights, loss of vision

Question 6

what are the signs of acute angle closure glaucoma?

Answer 6

red eye, corneal edema, shallow peripheral anterior chamber with cells and flare, IOP > 40mmHg

Question 7

what are the signs of a prior angle closure incident?

Answer 7

iris atrophy, posterior synechiae, gluakomflecken, optic nerve damage

Question 8

what are the signs of acute congestive angle-closure glaucoma?

Answer 8

corneal edema, ciliary injection, complete angle closure, shallow anterior chamber, mid-dilated pupil that is unreactive and vertically oval

Question 9

what technique would allow to determine if the patient has synechiae?

Answer 9

indentation gonioscopy

Question 10

what increases the risk for anterior synechiae formation?

Answer 10

long duration of iris being pushed against the angle

Question 11

what happens to the stroma during corneal epithelial edema? and what is the IOP?

Answer 11

aqueous is forced in the stroma

IOP around 50 mmHg

Question 12

what causes the pupil to remain mid-dilated and unreactive?

Answer 12

paralysis and ischemia of the pupillary sphincter due to increased IOP

Question 13

what is the reason for venous congestion (painful red eye)?

Answer 13

IOP exceeds that of episcleral veins

Question 14

how does abrupt increase in IOP affect the iris?

Answer 14

leads to iris atrophy due to reduction of blood flow to the iris

Question 15

what are the signs of post-congestive angle-closure?

Answer 15

folds in descemet’s membrane, stromal iris atrophy, posterior synechiae, glaukomflecken, fixed and dilate pupil

Question 16

what type of angle-closure glaucoma shares many symptoms with acute angle-closure glaucoma, but in a more intermittent appearance?

Answer 16

sub-acute angle closure

Question 17

what type of angle-closure glaucoma is easily missed? and what technique should be performed routinely?

Answer 17

chronic angle-closure glaucoma (requires routine gonioscopy)

Question 18

how can a lens contribute to angle closure glaucoma?

Answer 18

if it is thicker, if it is more anteriorly positioned and if it is more convex (increases chance of touching iris)

Question 19

why may angle-closure occur in patients with plateau iris?

Answer 19

due t oiridotrabecular apposition (caution when you dilate these patients)

Question 20

what is the common treatment for patients that have plateau iris with relative pupillary block?

Answer 20

peripheral iridotomy

Question 21

what IV medication (to decrease IOP) may you recommend for a nauseated angle-closure patient?

Answer 21

acetazolamide or mannitol

Question 22

what is the emergency pharmacological protocol for acute angle closure?

Answer 22

ABC’s

alpha-2 agonist, beta blocker, CAI

Question 23

once IOP is less than 40 mmHg, what other drop should you start to use on the patient?

Answer 23

pilocarpine

Question 24

what overnight drops should a patient with angle closure take?

Answer 24

prednisolone acetate, acetazolamide, pilocarpine and alpha agonist or beta blocker