Lecture 13: Glaucoma

Question 1

Does non-acute glaucoma cause pain?

Answer 1

No

Question 2

Is visual field loss secondary to guacoma reversible?

Answer 2

NO

Question 2

Describe aquous humor production and circulation?

Answer 2

• Ciliary processes produce aquous humor
• Flows through lens zonules (ligaments)
• Past lens intro ant. chamber
• Drains through angle into trabeculae network

Question 3

What is glaucoma?

Answer 3

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.

Question 4

What are the two principle types of glaucoma?

Answer 4

Open vs closed angle

Question 5

What are the causes of open angle glaucoma?

Answer 5

• Primary – presumed angle predisposition
• Secondary – cells, inflammation

Question 6

What are the causes of closed angle glaucoma?

Answer 6

Primary – narrow anterior chamber angle
* Secondary – tumours, synechiae (this is why we give them atropine or dilating eye drops)

Question 7

What are the four key components to glaucoma assessment?

Answer 7

1. Intraocular Pressure
2. Angle Assessment
3. Optic Nerve
4. Visual Fields

Question 8

What are the risk factors for open angle glaucoma?

Answer 8

• Age
• Family history
• Elevated eye pressure
• Myopia (short sightedness)
• African Descent
• Steroid medication
• High blood pressure
• Migraine sufferers

Question 9

What are the clinical features of open angle glaucoma?

Answer 9

Asymp. untila advanced visual field defects, peripheral vision goes first and brain replaces with what should be there.

Question 10

What is normal eye pressure?

Answer 10

10-21mmHg

Increased occular pressure is associated with glaucoma

Question 11

Whats this?

Answer 11

Glaucoma

Cupping of optic disc

Disc widens and brightens as neurons die.

Question 12

Which eye is worse?

Answer 12

Right eye, look at disc

Question 13

How do we treat glaucoma?

Answer 13

• 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”

Question 14

What are the side effects of prostaglandins analgoues?

Answer 14

1. Eyelash Growth
2. Change in Eye colour

Question 15

What are the side effects of beta blockers for the eye?

Answer 15

• Asthma
• Lower Blood Pressure
• Slower Pulse
• Dizziness
  Depression
  Vivid Dreams
  Impotence
  Hair Loss

Question 16

What are the side effects of alpha agonists?

Answer 16

• Allergies
• Fatigue
• Somnolence
• High Blood Pressure
• Dry Mouth
• Altered Taste

Question 17

What are the side effects of carbonic anhydrase inhibitors?

Answer 17

• Local Side Effects:
• Stinging/burning
• Conj hyperemia
• Crusty Eyelashes
• Systemic Side Effects
• Bitter taste

Question 18

What are some non-pharmacological tx for glaucoma?

Answer 18

• Laser; increased drainage
• Surgical: Trabeculotomy, microstents

Question 19

What are the signs and symptoms of acute closed angle glaucoma?

Answer 19

• 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

Question 20

Who is at risk for closed angle glaucoma?

Answer 20

1. Age over 60
2. Females greater than
   males (4:1)
3. Hyperopia
4. Asian ethnicity
5. Family history of angle
   closure with first degree
   relatives

Question 21

Whats the tx for acute closed angle glaucoma?

Answer 21

• Eye drops: Pilocarpinel timolol
• IV Acetozolimide or mannitol
• Laser (through iris to facilitate flow)
• Corneal indentation (opens angle)

Question 22

What are the indications for infantile glaucoma?

Answer 22

• Hazy corneas
• Tearing/watering
• Photophobia
• Buphthalmos