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Disease/glaucoma Dr. Davey 2016 > Lecture 9 normal tension glaucoma > Flashcards

Lecture 9 normal tension glaucoma Flashcards

1
Q

(T/F) Normal tension glaucoma (NTG) patients have IOP measurements consistently under 21mmHg and no more than 2 times over 24mmHg

A

True

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2
Q

Which one of the following is NOT true regarding normal tension glaucoma?

a) People with NTG have glaucomatous damage despite having lower than statistically normal pressures.
b) There is a higher prevalence of Raynaud’s phenomena, ischemic vascular disease, autoimmune disorders, vascular regulatory problems, and coagulopathies among those with NTG
c) NTG is a form of glaucoma that is highly associated with glass blowers or others in occupations who may have no protection against infrared radiation
d) NTG is progressive despite attempts at lowering IOP and studies indicate that eyes with asymmetric IOP have more damage in the eye with the higher IOP.

A

c) NTG is a form of glaucoma that is highly associated with glass blowers or others in occupations who may have no protection against infrared radiation (this is true for pseudoexfoliation syndrome)

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3
Q

Which one of the following is NOT associated with the Collaborative Normal Tension Glaucoma study (CNTGS)

a) There were more incidence of cataracts in controls vs treated groups
b) Lowering IOP slows progression rate of visual field loss compared with untreated eyes
c) The effect of treatment was only obvious after removal of cataract
d) Some progressed despite IOP lowering measures indicating IOP may not be the only factor

A

a) There were more incidence of cataracts in controls vs treated groups

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4
Q

Which one of the following regarding NTG is NOT true?

a) progression of NTG tends to be rapid
b) Visual field defects tend to be closer to fixation (not unusual to find a paracentral scotoma)
c) NTG pt’s have a thinner rim inferiorly and inferiotemporally when compared to other forms of glaucoma with similar visual field loss
d) local vascular factor play a role in NTG

A

a) progression of NTG tends to be rapid (false, tends to be slow)

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5
Q

Which one is NOT one of the 5 glaucomatous disc classifications?

a) Focal
b) Myopic
c) Senile sclerotic
d) Abnormal
e) Concentric
f) Advanced

A

d) Abnormal

  • Senile sclerotic–shallow sloping of neuroretinal rim
  • Focal ischemic–deep focal polar notching in the neuroretinal rim
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6
Q

Which one of the following is useful in determining the peak IOP?

a) target IOP
b) diurnal IOP
c) trough IOP
d) nighttime IOP

A

b) diurnal IOP (daytime IOP)

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7
Q

(T/F) Cataract development was greater for surgical groups when compared to meds or laser.

A

true

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8
Q

Which one is NOT important regarding diagnostic evaluation of NTG?

a) repeated IOP measurements at various intervals
b) gonioscopy to rule out angle closure, recession, or evidence of previous ocular inflammation
c) stereo optic disc to rule out other nonglaucomatous optic nerve disease
d) medical history
e) all of the above are important in diagnostic evaluation of NTG

A

e) all of the above are important in the diagnostic evaluation of NTG

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9
Q

Which of the following is not true regarding Pigment dispersion syndrome?

a) pigment deposits on corneal endothelium and TM
b) pigment also deposits on lens periphery
c) you find midperipheral transillumination defects
d) With pigmentary glaucoma there is less pigment than with exfoliation syndrome

A

d) With pigmentary glaucoma there is less pigment than with exfoliation syndrome (false, there is more pigment with pigment dispersion syndrome, XFS has patchy pigment deposits and the iris appears “moth-eaten”)

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10
Q

(T/F) A defining feature of pigment dispersion syndrome is homogenous TM pigmentation, whereas exfoliation syndrome shows uneven pigmentation.

A

true because there is much more pigment being dispersed.

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11
Q

Pigment dispersion syndrome does not always develop as glaucoma and it is most common in:

a) hyperopic white women over 50 years old
b) myopic african american males between the ages of 20-50
c) myopic white males between the ages of 20-50
d) hyperopic chinese women over 50 years old

A

c) myopic white males between the ages of 20-50

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12
Q

Which of the following is NOT true regarding Pigment dispersion syndrome:

a) pigment may be released after exercise
b) Wide IOP fluctuations
c) pigment deposits can be seen on zonular fibers
d) midperipheral iris is concave and bowing away from zonular fibers

A

d) midperipheral iris is concave and bowing away from zonular fibers (false, bowing towards, not away)

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13
Q

(T/F) Lens induced glaucoma can cause both open angle and angle closure glaucoma

A

true

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14
Q

Which one of the following is not one of the 3 types of open angle lens induced glaucoma?

a) phakolytic
b) aphakic
c) lens particle
d) phacoanaphylaxis

A

b) aphakic. Aphakic means NO lens so that wouldn’t make much sense.

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15
Q

(T/F) Phacolytic is a type of open angle lens induced glaucoma where the lens leaks protein through the capsule of a hypermature lens (morgagnian cataract)

A

true

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16
Q

(T/F) To treat an angle closure due to lens induced glaucoma you can use a miotic like pilocarpine, however, the side effects are an eyebrow headache and reduced visual fields.

A

true

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17
Q

Which one of the following is NOT true regarding lens particle glaucoma?

a) it is caused by cataracts
b) you may see a moderate anterior chamber reaction
c) with time posterior synechiae develop
d) Can occur within weeks to months of a cataract extraction

A

a) it is caused by cataracts (it is technically caused by the cataract extraction, by lens particles in anterior chamber post cataract extraction)

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18
Q

Which one of the following is NOT true regarding phacoanaphylaxis?

a) KP is present with moderate anterior chamber reaction
b) This is a more common form of lens induced glaucoma
c) results in granulomatous inflammation
d) Pt becomes sensitized to their own lens protein following cataract extraction or penetrating trauma
e) low grade vitritis, synechial formation, residual lens material in anterior chamber may be present

A

b) This is a more common form of lens induced glaucoma (false, its rare)

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19
Q

(T/F) Ocular tumors can cause unilateral chronic glaucoma

A

true

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20
Q

Which one of the following is NOT a method by which an ocular tumor can cause glaucoma?

a) angle closure by ciliary body rotation
b) intraocular hemorrhage
c) neovascularization of angle
d) anterior displacement od lens-iris diaphragm
e) tumor invasion of anterior chamber angle
f) deposition of tumor cells, inflammatory cells, and cellular debris within the TM
g) all of the above ARE methods

A

g) all of the above ARE methods

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21
Q

(T/F) Chorodal melanomas and other retinal and choroidal tumors cause secondary angle closure glaucoma

A

true

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22
Q

(T/F) Ocular inflammation and secondary open angle glaucoma often combine components of open angle and angle closure glaucoma

A

true

23
Q

Which one of the following is NOT a method by which ocular inflammation can cause glaucoma?

a) edema of TM
b) breakdown of blood aqueous barrier
c) TM endothelial cell dysfunction
d) steroid induced reduction of TM aqueous outflow
e) blockage of TM by fibrin and inflammatory cells
f) all of the above ARE methods

A

f) all of the above ARE methods

24
Q

Which one of the following is NOT true regarding elevated episcleral venous pressure?

a) its a important factor in regulation of IOP
b) its normally 8-10 mmHg
c) High episcleral venous pressure reduces aqueous outflow
d) chronic red eye is not a symptom

A

d) chronic red eye is not a symptom. (it is a symptom)

25
Q

Which one of the following is NOT a symptom of elevated episcleral venous pressure?

a) constricted episcleral veins
b) can be unilateral or bilateral
c) can have blood in schlemms canal
d) can be associated with a history of head trauma: carotid cavernous fistula or dural fistula

A

a) constricted episcleral veins (false, they are dilated), that is why one of the major symptoms is chronic red eye.

26
Q

(T/F) Non-penetrating trauma can cause a variety of anterior segment injuries that can lead to secondary glaucoma

A

true

27
Q

Which one of the following is NOT associated with trauma induced glaucoma?

a) hyphema
b) angle recession
c) iridodialysis or iris sphincter tear
d) lens subluxation
e) cyclodialysis
f) all of the above are associated

A

f) all of the above are associated

28
Q

(T/F) Miotics, such as Pilocarpine, are best for treating angle recession glaucoma

A

false. They will not work

29
Q

Which one of the following is NOT true regarding angle recession glaucoma?

a) pts are highly symptomatic
b) it can take 10 to 20 years to develop if not immediately due to trauma
c) gonio findings include: uneven iris insertion, torn iris, wide ciliary body band
d) miotics will not work

A

a) pts are highly symptomatic (false, pts are asymptomatic)

30
Q

(T/F) Prostaglandins are the first choice for inflammation induced glaucoma

A

false. Prostaglandins are pro-inflammatory and take 4-6 weeks to start working, they are never used for acute situations.

31
Q

(T/F) Corticosteroid induced glaucoma is an angle closure rather than an open angle glaucoma

A

false. Corticosteroid induced glaucoma is a form of open angle glaucoma. it mimics POAG. Caused from prolonged use of any corticosteroid in any form, however, the closer they are to the eye increases risk of steroid responder in the eye.

32
Q

(T/F) Systemic administration of steroid increases IOP in some individuals, however, to a lesser degree

A

true. Also, a high percentage of POAG pts show response to topical corticosteroid

33
Q

What is the corticosteroid reaction in response to?

A

the response is due to an increased resistance to aqueous outflow in TM

34
Q

Of the following corticosteroids, which 4 are less likely to raise IOP and which 3 are more likely?

a) flurometholone
b) rimexolone
c) medrysone
d) loteprednol
e) prednisolone
f) dexamethasone
g) durezol

A

a) flurometholone (least)
b) rimexolone (least)
c) medrysone (least)
d) loteprednol (least)
e) prednisolone (most)
f) dexamethasone (most)
g) durezol (most)

*Steroid responders may have raised IOP even to weaker steroids

35
Q

(T/F) IOP decreases if the steroid use is stopped/discontinued

A

true (also, it usually takes weeks for the spike to occur

36
Q

What is the most common cause of neovascular glaucoma?

a) raynauds phenomena
b) sjogren syndrome
c) diabetes mellitus
d) arthritis

A

c) diabetes mellitus (as far as I know, the other 3 have nothing to do with neovascular glaucoma) **most common cause is diabetes mellitus, also, central retinal vein occlusion

37
Q

(T/F) Cycloplegic drugs and routine dilation may cause an increase in IOP

A

true

38
Q

Which one of the following is NOT associated with neovascular glaucoma?

a) contraction of an inflammatory hemorrhagic or vascular membrane band or exudates in the angle leading to PAS
b) posterior displacement of the iris lens diaphragm often accompanied by swelling and anterior rotation of the ciliary body
c) common, severe angle closure glaucoma caused by a variety of disorders
d) most common causes are diabetes mellitus and central vein occlusion

A

b) posterior displacement of the iris lens diaphragm often accompanied by swelling and anterior rotation of the ciliary body (false, replace the word “posterior” with “forward” and it becomes a true statement)

39
Q

Ice syndrome is a ______ disorder?

a) iris
b) lens
c) corneal epithelium
d) corneal endothelium

A

d) corneal endothelium

40
Q

Which syndrome is associated with a “hammer-silver” appearance?

a) cogan-reese syndrome
b) chandler syndrome
c) aqueous misdirection syndrome
d) none of the above

A

b) chandler syndrome (it is also associated with corneal edema, pt complains of halos)

41
Q

What percentage of ICE (irido-corneal endothelial) cases develop into glaucoma?

a) 15%
b) 25%
c) 50%
d) 65%

A

c) 50%

42
Q

Which one of the following is NOT true regarding Chandler syndrome?

a) Pts with Chandler syndrome make up 80% of ICE cases
b) high PAS caused by the contraction of endothelial layers
c) minimal iris atrophy
d) PAS results in angle closure

A

a) Pts with Chandler syndrome make up 80% of ICE cases (false, 50%)

43
Q

(T/F) ICE (irido-corneal endothelial) syndromes cause variable degree of iris atrophy, secondary angle closure, and corneal edema

A

true. Also, vision decreases with cornal edema and the edema is painful. It may only affect one eye.

44
Q

Which one of the following is NOT considered an ICE (irido-corneal endothelial) syndrome?

a) Chandler syndrome
b) aqueous misdirection syndrome
c) progressive iris atrophy
d) iris nevus/cogan-reese syndrome

A

b) aqueous misdirection syndrome

45
Q

Which one of the following is NOT a sign regarding progressive iris atrophy?

a) broad band PAS and heterochromia
b) correctopia (displaced pupil toward location of PAS)
c) ectropion uveae (uvea spills out into ant. chamber)
d) minimal iris atrophy

A

d) minimal iris atrophy (false, its severe atrophy)

46
Q

Which one of the following is NOT true regarding iris nevus/cogan-reese syndrome?

a) severe iris atrophy
b) distinguished by pedunculate nodules or diffuse pigment lesions
c) it is considered an ICE (irido-corneal endothelial) syndrome

A

a) severe iris atrophy (false, its minimal iris atrophy)

47
Q

Glaucomatocyclic syndrome is also known as:

a) aqueous misdirection syndrome
b) cogan-resse syndrome
c) down syndrome
d) Posner-schlossman syndrome

A

d) Posner-schlossman syndrome (a unilateral, young to middle aged, recurrent syndrome)

48
Q

Which one of the following is NOT a sign or symptom of Posner-schlossman (glaucomatocyclitic crisis)?

a) mild pain with fine keratic precipitates
b) corneal edema causing rainbow halos and reduced vision
c) IOP is 40-60 and constricted pupils
d) closed angle due to synechiae
e) mild anterior chamber reaction due to breakdown of blood aqueous barrier
f) iris hypochromia

A

d) closed angle due to synechiae (false, open angle with no synechiae)

49
Q

Which one is NOT the appropriate treatment for posner-schlossman syndrome (glaucomatocyclitic crisis)?

a) prostaglandin analog
b) a2 agonist
c) beta blocker
d) CAI

A

a) prostaglandin analog (you never want to use a PG with inflammation and PG’s take up to 4-6 weeks to start working anyway)

50
Q

(T/F) Aqueous misdirection syndrome is also known as malignant glaucoma

A

true. It classically follows surgery with small anterior chamber.

51
Q

Which of the following syndromes has a noticeable myopic shift (near vision gets better)?

a) aqueous misdirection syndrome
b) cogan-resse syndrome
c) down syndrome
d) Posner-schlossman syndrome

A

a) aqueous misdirection syndrome

52
Q

Which one of the following is NOT a sign or symptom of aqueous misdirection syndrome?

a) mild to moderate pain
b) hyperopic shift
c) evidence of peripheral iridotomy
d) absence of choroidal detachment or iris bombe

A

b) hyperopic shift (false, myopic shift)

53
Q

Which one of the following is NOT a pathophysiology theory for aqueous misdirection syndrome?

a) posterior misdirection of aqueous trapping fluid in posterior chamber in PVD pocket (Shaffer and Hoskins)
b) Laxity lens zonules and increased aqueous pushes lens and iris firmly forward and increases with time (Chandler)
c) combination of both a and b and also including choroidal expansion first followed by anterior chamber shallowing (Quigley)
d) all of the above are the 3 theories of pathophysiology regarding aqueous misdirection syndrome

A

d) all of the above are the 3 theories of pathophysiology regarding aqueous misdirection syndrome

54
Q

What is the management pathway for malignant glaucoma?

A

1) First try cycloplegics, aqueous suppressors, osmotic agents, or steroids
2) If pt is phakic go straight to surgical therapy (no laser)–cataract extraction with IOL implantation, posterior capsulotomy, and vitrectomy
2b) If pt is psuedophakic or aphakic next step is laser–Nd-yag laser capsulotomy and disruption of anterior hyaloid face–then try transcleral cyclodiode laser—then try surgical—vitrectomy surgery

Disease/glaucoma Dr. Davey 2016 (13 decks)

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