primary open glaucoma

Question 1

what are Glaucomas

Answer 1

GRADUAL rise in intraocular pressure (IOP)

Question 2

how are glaucoma’s classified ?

Answer 2

whether the peripheral iris is covering the trabecular meshwork,

which is important in the drainage of aqueous humour from the anterior chamber of the eye

Question 3

In open-angle glaucoma is the meshwork blocked ?

Answer 3

iris is clear of the meshwork

however - trabecular network functionally offers an increased resistance to aqueous outflow, causing increased IOP

Question 4

cause of open angle glaucoma?

Answer 4

(Remember sturge weber syndrome ) - a red or pink birthmark called a port-wine birthmark, a brain abnormality called a leptomeningeal angioma, and increased pressure in the eye (glaucoma

Question 5

Risk factors of open angle glaucoma?

Answer 5

increasing age

genetics
first degree relatives of an open-angle glaucoma patient have a 16% chance of developing the disease

Afro Caribbean ethnicity

myopia

hypertension

diabetes mellitus

corticosteroids

Question 6

x

Question 7

clinical features of primary open glaucoma ?

Answer 7

gradual onset of visual changes over the years / May present insidiously

Nasal scotoma - loss of vision around the nasal area
= this progresses to tunnel vision

gradual deterioration of the vision

Question 8

x

Question 9

x

Question 10

x

Question 11

diagnosis of open angle glaucoma

Answer 11

tonometry - IOP of ≥ 24 mmHg

Fundoscopy
1. Optic disc cupping - cup-to-disc ratio >0.7
Optic disc pallor - indicating optic atrophy

Question 12

x

Question 13

x

Question 14

x

Question 15

first-line to people with an IOP of ≥ 24 mmHg?

Answer 15

360° selective laser trabeculoplasty (SLT)

a second 360° SLT procedure may be needed at a later date

Question 16

second line for primary open glaucoma ?

Answer 16

prostaglandin analogue (PGA) eyedrops - latanoprost

Question 17

third line for primary open glaucoma ?

Answer 17

beta-blocker eye drops - timolol

carbonic anhydrase inhibitor eye drops - azetozolamide / brinzolamide

sympathomimetic eye drops

Question 18

refractory cases of primary open glaucoma ?

Answer 18

surgery in the form of a trabeculectomy

Question 19

function of Prostaglandin analogues (e.g. latanoprost)?

Answer 19

Increases uveoscleral outflow

Question 20

adverse effect of Prostaglandin analogues (e.g. latanoprost)?

Answer 20

Adverse effects include brown pigmentation of the iris, increased eyelash length

Question 21

when taking Sympathomimetics (e.g. brimonidine, an alpha2-adrenoceptor agonist) what drugs do we avoid ?

Answer 21

MAOI - isocarboxazid, phenelzine

or tricyclic antidepressants