Lecture 13: Glaucoma Flashcards
Does non-acute glaucoma cause pain?
No
Is visual field loss secondary to guacoma reversible?
NO
Describe aquous humor production and circulation?
- Ciliary processes produce aquous humor
- Flows through lens zonules (ligaments)
- Past lens intro ant. chamber
- Drains through angle into trabeculae network
What is glaucoma?
Glaucoma is an optic neuropathy with a specific pattern of axonal loss which may be associated with elevated intraocular pressure and a typical pattern of visual field loss.
What are the two principle types of glaucoma?
Open vs closed angle
What are the causes of open angle glaucoma?
- Primary – presumed angle predisposition
- Secondary – cells, inflammation
What are the causes of closed angle glaucoma?
Primary – narrow anterior chamber angle
* Secondary – tumours, synechiae (this is why we give them atropine or dilating eye drops)
What are the four key components to glaucoma assessment?
- Intraocular Pressure
- Angle Assessment
- Optic Nerve
- Visual Fields
What are the risk factors for open angle glaucoma?
- Age
- Family history
- Elevated eye pressure
- Myopia (short sightedness)
- African Descent
- Steroid medication
- High blood pressure
- Migraine sufferers
What are the clinical features of open angle glaucoma?
Asymp. untila advanced visual field defects, peripheral vision goes first and brain replaces with what should be there.
What is normal eye pressure?
10-21mmHg
Increased occular pressure is associated with glaucoma
Whats this?
Glaucoma
Cupping of optic disc
Disc widens and brightens as neurons die.
Which eye is worse?
Right eye, look at disc
How do we treat glaucoma?
- Prostaglandins analogues; increase uveoscreal outflow “prost”
- Beta blockers; decrease aquous humor production “lol”
- Alpha agonists: Dual effect, increase uveoscleral outflow and decrease AH prod. “onidine”
- Carbonic anhydrase inhibitors: Decrease AH production “olamide”
What are the side effects of prostaglandins analgoues?
- Eyelash Growth
- Change in Eye colour
What are the side effects of beta blockers for the eye?
- Asthma
- Lower Blood Pressure
- Slower Pulse
- Dizziness
Depression
Vivid Dreams
Impotence
Hair Loss
What are the side effects of alpha agonists?
- Allergies
- Fatigue
- Somnolence
- High Blood Pressure
- Dry Mouth
- Altered Taste
What are the side effects of carbonic anhydrase inhibitors?
- Local Side Effects:
- Stinging/burning
- Conj hyperemia
- Crusty Eyelashes
- Systemic Side Effects
- Bitter taste
What are some non-pharmacological tx for glaucoma?
- Laser; increased drainage
- Surgical: Trabeculotomy, microstents
What are the signs and symptoms of acute closed angle glaucoma?
- sudden onset painful red
eye - pain may -> vomiting
- may see rainbow halos
round lights - decreased visual acuity
due to corneal oedema - semidilated oval pupil
- stony hard eyeball
Emergency
Who is at risk for closed angle glaucoma?
- Age over 60
- Females greater than
males (4:1) - Hyperopia
- Asian ethnicity
- Family history of angle
closure with first degree
relatives
Whats the tx for acute closed angle glaucoma?
- Eye drops: Pilocarpinel timolol
- IV Acetozolimide or mannitol
- Laser (through iris to facilitate flow)
- Corneal indentation (opens angle)
What are the indications for infantile glaucoma?
- Hazy corneas
- Tearing/watering
- Photophobia
- Buphthalmos
