Open and Closed Angle Glaucoma ☺️

Question 1

What are glaucomas

-types

Answer 1

Optic neuropathies associated with increased intraocular pressure

• drainage hole ant to iris clogged => open angle
• iris pushes forwards and blocks drainage hole

Question 2

Epidemiology

Etiology of POAG

Answer 2

Increases with age
Both sexes affected equally

Genetics
Black
Myopia
HTN
DM
CS use

Question 3

Symptoms and signs
Investigations
Diagnosis of POAG

Answer 3

Asymptomatic
Bilateral progressive peripheral => central visual loss
Decreased acuity
Increased optic disc cupping

Gonioscopy - angle
Tonometry - IOP (24mmHg+)
Fundoscopy - increased optic disc cupping
Perimetry - visual field assessment

Question 4

Management of POAG

-1st, 2nd line

Answer 4

First line - prostaglandin analogue eyedrops (latanoprost) => lower IOP to prevent progressive loss of visual field

Second line - Bb(timolol), CAinh (dorzolamide), sympathomimetic (apraclonidine a2agonist) eyedrops

Surgery (trabeculectomy), laser treatment may be an option

Must reassess visual field loss regularly

Question 5

Risk factors for AACG

Answer 5

Long sightedness
Pupillary dilation
Lens growth linked with age

Question 6

Symptoms and signs of AACG

Answer 6

Severe eye/headache
Decreased visual acuity
Symptoms worse with pupil dilation
Hard, red eye
Halo around lights
Semi-dilated non reacting pupil
Dull/hazy cornea => corneal edema
N+V, abdo pain

Question 7

Management of AACG

Answer 7

URGENT REFERRAL TO OPTHALMOLOGIST, AN EMERGENCY

1. lower IOP via combination of eyedrops to increase outflow and decreased humour prod
   - pilocarpine, timolol, acetazolamide
2. definitive management of laser peripheral iridotomy
   - create hole in peripheral iris to allow humour to drain