Sample Qs 2 Flashcards
CG85
New mild/moderate
First line 360 SLT
If SLT not suitable/declined/waiting - PGA
PGA is additional treatment to lower IOP
Second 360 SLT if initial SLT effects reduced over time
If cannot tolerate PGA consider bB/CAI/Alpha agonist or P.f. drops
After treatment with 2 classes consider 360 SLT or glaucoma surgery with MMC
If not reduced with surgery:
further surgery
Pharmacological treatment
Cyclodiode
360 SLT
Advanced COAG
Glaucoma surgery
PGA while waiting
If declined - SLT, pharm or cyclodiode
What is laser trabeculoplasty? What are indications?
Laser to angle structures resulting in opening of trabecular meshwork and widening of Schlemms canal
Open angle glaucoma with pigmented trabeculum
What laser is used in SLT
Q-switched frequency-doubled Nd-yAG
Side effects:
Transient reversible epitheliopathy
Bleeding
Inflammation
What is argon laser peripheral iridoplasty? Indication?
Argon laser to peripheral iris results in contraction or iris and widening of angle
Plateau iris syndrome, APAC
What is plateau iris syndrome?
Peristently narrow or closed angle despite a patent PI, often leading to angle closure - caused by iris being positioned anteriorly on the ciliary body or anterior displacement of the ciliary body
Order of gonioscopy
IRIS ROOT
Ciliary Body
Scleral spur
Pigmented trabecular meshwork
Anterior trabecular meshwork
Schwalbe Line
ICSPAS Posterior to Anterior
What is Schwalbe’s Line
The termination of the Descemet membrane of the cornea
What is transcleral diode cyclophotocoagulation (cyclodiode)? Indications? Complications?
Destruction of ciliary body with Nd-YAG (frequency 1064) or diode
Indications:
Intractable raised IOP
(rubeotic or synechial angle closure where other mechanisms have failed)
Break attacks of malignant glaucoma
Temporising measure until trabeculectomy
Complications:
Anterior inflammation
Hypotony
Scleral thinning
Perforation
Phthisis
Cataract
Lens subluxation
Sympathetic endophthalmitis
What is ECP? Indications? Complications?
Endodiode laser photocoagulation (endoscopic cyclophotocoagulation
DIrect photocoaulgation of ciliary processes under endoscopic visualisation
Complications:
CMO, cataract, inflammation, endophthalmitis, RD, SCH, hypotony, phthisis
Where is the lesion in internuclear ophthalmoplegia? What does this connect?
Medial longitudinal fasciculus
Connects nuclei of IPSI 3rd and CONTRA 6th
What happens in internuclear ophthalmoplegia?
Failure of ipsilateral adduction (IPSI 3)
Overshoot of CONTRAlateral eye (CONTRA 4th LR6) Ataxic nystagmus best demonstrated on saccadic movements,
May be assocaited with upbeat and torsional nystagmus, loss of vertical smooth pursuit, skew deviation (acquired vertical misalignment of the eys not due to any single muscle of ocular motor nerve.
CONVERGENCE IS PRESERVED IN UNILATERAL LESIONS
What is the VOR?
Vestibulo ocular Reflex - Stabilises gaze and maintains a clear visual field during head movements by triggering eye movements in the opposite direction to compensate fo head motion ensuring a stable retinal image.
What is Duane Syndrome?
COINERVATION OF LR AND MR BY 3rd nuclei
(may be associated with 6ht nuclei hypoplasia)
Results in restriction of horizontal gaze
Retraction of globe (with reduction of palpebral aperture) on attempted adduction
Up/downshoot on attempted adduction
Type 1 Duane
Primary position: ORTHO OR ESO
Primary feature: REDUCED ABDUCTION
Globe retraction: MILD
Most common 85%
Type 2 Duane
Primary postion: ORTHO OR EXO
Primary feature: REDUCED ADDUCTION
Globe retraction: SEVERE
14%
Type 3 Duane
Primary position: ORTHO OR ESO
Primary feature: Reduced ABDUCTION AND ADDUCTION
Globe retraction: MOD
1%
What is treatment for Duane
Unilateral/Bilateral MR recession for esotropic Duane
Unilateral/bilatearl LR recession for exotropic Duane
What is Brown Syndrome
Mechanical restriction
Structural or developmental abnormalities of the superior oblique muscle tendon of the trochlea.
Limitation in the direction of its antagonist (inferior oblique) due to apparent failure of relaxation of the superior oblique.
LIMITED ELEVATION IN ADDUCTION
PAIN/CLICK during resolution
Limited sequelae (overaction of contralateral SR only)
V pattern
May downshoot in adduction
Positive forced duction test
What are causes of Brown’s
In most cases, it is congenital and usually improves or resolves by 12 years.
Acquired cases may arise due to trauma, surgery (SO tuck, buckle, orbital) or inflammation (RA/sinusistis)
What is treatment for Brown’s
Reassure if managing well with minimal/mild compensatory head posture
Usually improves with age
Consider surgery if significant abnormal head posture or if strab in primary position
Aim to release the restriction.
SO tenotomy
Acquired cases may be treated with periocular or oral corticosteroid
What is Moebius Syndrome?
Congenital
Bilateral 6th and 7th palsy
Associated with bilateral tight MR causing restriction
Bilatearl failure of abduction - may be pure gaze palsy or bilateral tight MR - esotropia and positive forced duction test
Bilateral 7th palsy - expressionless face
Bilateral 12th palsy - atrophic tongue
What causes V pattern strabismus?
More divergent in upgaze than downgaze
IOOA / SO palsy
V pattern esotropia - chin down posture
IOOA
V pattern exotropia - chin up posture
How do you adjust the MR and LR for V pattern strabismus?
MR/LR transposition
MALE
MR towards Apex, LR towards Ends
V - MR down, LR up
