Test 2: lecture 32 glaucoma

Question 1

— is the major cause of blindness

Answer 1

glaucoma

Question 2

what is glaucoma

Answer 2

OPTIC NEUROPATHY: Neurodegenerative disease causing irreversible damage to optic nerve (axons of retinal ganglion cells)

increased intraocular pressure

Question 3

what happens to optic nerve with glaucoma

Answer 3

will degrade

optic disc cupping

Question 4

aqueous humor is made by what enzyme

Answer 4

ciliary processes of the ciliary body

carbonic anhydrase catalyzes aqueous humor production

Question 5

conventional outflow of AH

Answer 5

made in ciliary body
drains through iridocorneal angle into trabecular meshwork

Question 6

unconventional outflow of AH

Answer 6

uveoscleral outflow

flows into vessels and leaves

Question 7

acute vs chronic glaucoma

Answer 7

acute- vision can still be saved

chronic- irreversible vision loss

Question 8

how to measure IOP

Answer 8

tonometry

Question 9

clinical signs of acute glaucoma

Answer 9

optic disc still normal: no cupping
pain: blinking, squinting
vision: menace/PLR/dazzle (±), mydriasis (±) normal to mildly abnormal optic disc
apperance: red(conjunctival/episcleral injections diffuse), diffuse corneal edema, normal globe size

Question 10

clinical signs of chronic glaucoma

Answer 10

+/- pain

vision:
* menace/PLR/dazzle (-)
* mydriasis
* retinal atrophy

apperance:
* conjunctival/episcleral injection
* diffuse corneal edema (mild-severe)
* buphthalmia (large cow eye)→ Haab’s striae( descets membrane breaks), lens luxation

Question 11

Answer 11

episcleral injection- big thick vessels

conjunctival hyperemia- diffusely red

Question 12

large cow eye is caused by chronic glaucoma

Answer 12

buphthalmia

increase IOP for long time

Question 13

how to see iridocorneal angle

Answer 13

gonioscopy

Question 14

primary glaucoma is a — problem.

Answer 14

structural problem
risk is always bilateral

• Primary closed/narrow-angle glaucoma (PCAG)
• Pectinate ligament dysplasia - not enought holes to let AH out

Question 15

two causes of primary glaucoma

Answer 15

• Primary closed/narrow-angle glaucoma (PCAG)
• Pectinate ligament dysplasia - not enought holes to let AH out

risk is always bilateral

Question 16

what does it mean that risk is bilateral in primary glaucoma

Answer 16

both eyes will eventually go blind

could take years or weeks but both eyes have the same structural problem and leads to galucoma enentually

Question 17

what gene mutation causes primary open-angle glaucoma

Answer 17

ADAMTS10 in beagles and elkhound

ADAMTS17 in bassets

Question 18

how can anterior uveitis cause secondary glaucoma

Answer 18

cells that leak into the anterior chamber can block angle and lead to increased IOP →glaucoma

aqueous flare= proteins flooding into the eye

Question 19

— lens luxation can lead to secondary glaucoma

Answer 19

anterior

eye emergency

Question 20

how to medically treat glaucoma by decreasing AH production

Answer 20

carbonic anhydrase inhibitors- stop AH production- dorzolamide

β blockers- block receptors on ciliart epithelium- Timolol

Question 21

how to medically increase AH outflow

Answer 21

Prostaglandin Analogues -
* Latanoprost increases uveoscleral outflow - causes uveitis to allow fluid to leave through vessels

miotics-
* Cholinergic: Pilocarpine
* Anticholinesterase: Demecarium brom

Question 22

how to increase AH outflow surgically

Answer 22

anterior chamber shunt

Question 23

how to reduce AH production surgerically

Answer 23

damage/laser/ablate ciliary body