PDS

Question 1

What is PDS

Answer 1

Common in young (30/40) male, myopic, caucasian patients. It is usually bialteral alright can be asymmetric. Recall that PDS is due to excessive bowing of the iris psoteirorly, resulting in contact between the iris and lens zonules, and the release of pigment from the posterior pigmented iris epithelium.

Question 2

Signs of PDS

Answer 2

K spindle
TIDS
Pigment on anterior capsule of the lens and iris surface
Hyperpigmentation of TM

Question 3

Pigment release in PDS

Answer 3

Often increased with jarring exercise to with dilation resulting in a temporal block of aqueous humor outflow throuh the TM with subsequent increase in IOP and corneal edema; pts may complain of temporary blurred vision and halos around lights during these epidsode. Less pigment release over time may occur as the lens thickens , resulting in less contact between the post pigment epithelial of iris and the lens zonules

Question 4

Hallmark of PDS

Answer 4

K spindle
RIDS
Sampaolesi line

Question 5

PXF

Answer 5

Age related systemic condition that is most common in elderly caucasian (Scandinavian). Characterized by breakdown of basement membranes thrghouout the body, including ocular structures

Question 6

Ocular signs of PDX

Answer 6

May be unilateral or bilateral

• abnormal, white, flaky deposits on pupillary margin, the anterior lens capsule (in a bulls eye pattern, the lens zonules, and the TM)
• the PXF material on the lens zonules often results in the release of pigment form the posterior pigmented iris epithelium, leading to an accumulation of pigment within the TM (similar to PDS)

Question 7

Sampoalesi line

Answer 7

Characterized by increased pigmentation anterior to Schwalbes line in the anterior chambe angel, it is associated with PDS and PXF

Question 8

Risk of glaucoma in PXF

Answer 8

15% within 10 years; PXF is the most common identifiable cause of elevated IOP and resulting secondary open angle glaucoma

Question 9

Fuchs heterochromic iridocyclitis

Answer 9

Chronic, nongran low grade anterior uveitis with stellate KPs; May also present with heterochromia of iris (due to chronic inflammation) and iris and/or angle neo in the affected eye. At an increased risk of glaucoma (due to chronic damage to TM) and cataracts (due to chronic inflammation).

Question 10

Posner schlossman syndrome

Answer 10

Characterized by acute trabeculitis that causes an acute elevation in IOP (40-60), resulting in blurred vision. Patients will have an open angle on gonio and very few cells in the AC, the condition is characterized by recurrent unilateral episodes.

Question 11

POAG

Answer 11

Most common optic neuropathy characterized by excavation of the optic nerve with corresponding VF defects (often bialteral and asymmetric), with an open angle on Gino and elevated IOP.

Question 12

MS and blurred vision

Answer 12

Uhtoffs phenomenon. After exercise

Question 13

What test should always be performed on patients with elevated IOP

Answer 13

Gonio

Question 14

IOP elevation occurs in what ways due to PDS

Answer 14

Physical blockage of the TM pores by released iris pigment

Toxicity to the endothelial cells and the TM fibers due to accumulated iris pigment

Question 15

Risk of glaucoma in PDS

Answer 15

109% at 5 years

15% at 15 years

Question 16

What percent of RNFL fibers need to be damaged in order to have a VF defect

Answer 16

50%

Question 17

OHTS and pachs

Answer 17

Thinner pachs have incereased risk of glaucoma

Question 18

GDx

Answer 18

Evans the thickness of the RNFL

Question 19

Order of angle structures on gonio

Answer 19

Iris 
CB
Scleral spur 
TM
Schlemms 
Schwalbes

Question 20

MOA of pilo

Answer 20

Cholinergic agonist that causes ciliary contraction, which pulls the scleral spur posterior and opens up the pores of the TM. This allows for increased AH flow through the TM.

Can also cause miosis

Question 21

MOA of prostaglandin

Answer 21

Increase in AH outflow through uveoscleral meshwork

Xalatan, latanaprost, lumigan

Question 22

MOA of docosanoid compound (rescula)

Answer 22

Increases AH outflow through the TM

Question 23

BBlockers MOA

Answer 23

Timolol, istaolol, timoptoc, betimol, betagan, betoptic

Decreases AH production

Question 24

A agonist MOA

Answer 24

Decrease AH production and increases US outflow

Iopidine, alphagan

Question 25

Cholinergic agonists MOA

Answer 25

Increase AH outflow through TM

Question 26

CAI MOA

Answer 26

Inhibits CA, an enzyme involved in AH production

Question 27

What drugs should not be RXed to a patient with sulfa allergies

Answer 27

CAIs

Question 28

When should you not give someone pilocarpine for glaucoma

Answer 28

If they have lattice

Question 29

TX for PDS

Answer 29

Not treated until there is an increase in IOP and/or optic nerve damage.
Treated the same as POAG, although this is often more aggressive and diffcicult to control