Primary Open Angle Glaucoma

Question 1

Pathophysiology of open angle glaucoma

Answer 1

Ophathlmological emergency

Gradual increased resistance to aqueous humour outflow through trabecular meshwork despite open iridocorneal angle,
Resulting in increased IOP and therefore retinal ganglion cell death and vision loss

Question 2

Risk factors of open angle glaucoma?

Answer 2

Black ethnicity
Myopia
Age >65
Hxn
T2DM
CVD
Untreated ocular hypertension
Family history

Question 3

Signs and symptoms of open angle glaucoma?

Answer 3

Usually asymptomatic
Gradual onset peripheral vision loss progressing to central vision loss at end stage
Fluctuating pain
Headaches
Blurry vision
Halos around lights

Question 4

Investigations for open angle glaucoma

Answer 4

Fundoscopy - with handheld ophthalmoscope/slit lamp to assess for optic disc cupping
Non contact tonometry - screen for IOP
Visual field assessment
Goldmann applanation tonometry (gold standard for measuring IOP)
Gonioscopy
central corneal thickness assessment

Question 5

Management of open angle glaucoma

Answer 5

Managed if IOP is 24 or above

360 selective laser trabeculoplasty (SLT)

Latonoprost drops to increase uveosacral outflow

Timolol drops to reduce aqueous humour production

Dorzolamide

Brimonidine

Trabeculectomy surgery

Question 6

What is glaucoma?

Answer 6

Group of diseases characterised by Progressive optic neuropathy