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Eye Disease > Pathogenesis of Glaucoma > Flashcards

Pathogenesis of Glaucoma Flashcards

1
Q

What is a key feature of glaucoma?

A

Loss of retinal ganglion and thinning of the retinal nerve fibre layer

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2
Q

Name the five risk factors of glaucoma

A

1) Black ethnicity
2) Intraocular pressure >26mmHg
3) Myopia
4) Diabetes
5) FH

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3
Q

What are the clinical features of glaucoma?

A
  • Thinning of the NRR
  • Disc cupping
  • Visual field loss
  • Asymmetric between the eyes
  • Raised IOPs–> important in screening for the disease
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4
Q

With primary angle closure glaucoma, what is the clinical features?

A

Close angle- this can be seen with gonioscopy

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5
Q

What is peripheral anterior synechiae?

A

Points of attachment between the trabecular meshwork and iris

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6
Q

What is iris block?

A

Pupil margin is attached to the anterior surface of the lens which causes a ballooning forward

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7
Q

What increases the risk of progression of glaucoma of closed angle glaucoma?

A

Raised IOPs

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8
Q

In open angle glaucoma, what causes raised IOPs?

A

Increased resistance to outflow

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9
Q

What produces aqueous?

A

Ciliary epithelium (pars plicata)

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10
Q

What are the two ways that aqueous is excreted?

A

1) Irido-corneal angle - Canal of Schlemm/ trabecular meshwork (70-90%)
2) Uveoscleral outflow (10-30%)

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11
Q

What is the IOP determined by?

A

Aqueous production and aqueous drainage

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12
Q

Describe the mechanism of aqueous production

A

The double epithelium of ciliary epithelium (pigmented layer and non-pigmented layer) work together to produce aqueous, formed by ion-driven transport system. The ions are transported from the ciliary stroma to the pigmented epithelium then by gap junctions to non-pig epithelium. Then is ACTIVELY transported into the posterior anterior chamber

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13
Q

What enzyme plays a huge role in aqueous secretion?

A

Carbonic anhydrase

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14
Q

What is prostaglandin analogues and give an example of a type.

A

Drug used to treat open angled glaucoma, an example is latanoprost

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15
Q

Do you know different layers of the trabecular meshwork?

A

No- go through it

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16
Q

What layer of the trabecular meshwork causes resistance to outflow?

A

Juxtacanalicular

17
Q

What two ways which helps to reduce resistance of the outflow from the trabecular meshwork?

A

1) Drugs
2) Laser therapy

18
Q

How does laser therapy lower IOPs?

A

Burns holes to open up spaces for the aqueous to be drained out of

19
Q

With secondary open-angle glaucoma what causes the IOPs to increase?

A

Meshwork becomes blocked with materials such as pigment and inflammatory material

20
Q

What is uveo-scleral outflow?

A

It enters the ciliary body and is removed via vascular routes

21
Q

Describe the mechanism of optic nerve damage.

A

Stress and strain is put on the ONH due to raised IOPs and this compression can result in remodelling the lamina cribosa which leads to axonal disruption then apoptosis and degeneration of retinal ganglion cells.

22
Q

What is an alternative way the ONH can become damaged? (Hint; it is a vascular mechanism)

A

Interruption to blood supply- raised IOPs can reduce ocular blood flow which leads to axons being deprived of nutrients (ishaemic mechanism)

23
Q

What three kinds of drugs inhibit aqueous production?

A

1) Beta blockers (block beta receptors)
2) Alpha receptor agonist (stimulate alpha receptors)
3) Carbonic anhydrase inhibitors

24
Q

What is pilocarpine?

A

Muscarinic agonist - opens up the trabecular meshwork

Contraction of ciliary muscles - widens up the space

25
Q

What is the first line of drugs used to treat glaucoma?

A

Prostaglandin agonists

26
Q

Name three surgery methods to improve drainage

A

1) Selective laser trabeculoplasty
2) Trabeculectomy
3) Minimally invasive glaucoma surgery

27
Q

What is selective laser trabeculoplasty?

A

Punching holes in the TM to open up the pathway

28
Q

what is Trabeculectomy?

A

Creates a new aqueous outflow pathway from posterior chamber to ocular surface

29
Q

What is Minimally invasive glaucoma surgery?

A

Tubes or stents put in the eye to take aqueous form anterior chamber to be drained into the supra choroidal space

Eye Disease (48 decks)

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