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Special Senses > The Eye > Flashcards

The Eye Flashcards

1
Q

What is glaucoma?

A

Glaucoma is damage to the optic nerve leading to loss of vision and blindness.

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2
Q

What are the different classifications of glaucoma?

A

Ocular Hypertension
Primary - Open Angle and Closed Angle
Secondary
Developmental

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3
Q

What causes primary glaucoma?

A

Primary glaucoma can be open and closed. Open is caused by obstruction of outflow through trabeculuar meshwork and then closed angle is caused by reduction of outflow due to angle closure.

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4
Q

What causes secondary glaucoma?

A

Secondary glaucoma is caused by inflammation, tumours and abnormalities.

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5
Q

What patient population would developmental glaucoma occur in?

A

Developmental glaucoma would occur in babies, children and teens.

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6
Q

What is the Aqueous Humour?

A

The aqueous humour is a clear fluid present between the cornea and lens.

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7
Q

What effect does the aqueous humour have on pressure within the eye?

A

Production and drainage of AqH controls the pressure within the eye, normal pressure is 10-21mHg.

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8
Q

How does the aqueous humour relate to glaucoma?

A

Increased IOP is a risk factor of glaucoma and can be managed with intervention.

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9
Q

What is the Conventional pathway for the drainage of the aqueous humour?

A

The ciliary body produces the AqH which then is drained through the trabeculuar meshwork at a angle.

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10
Q

What is the non-conventional pathway for AqH drainage?

A

The AqH is produced by the ciliary body and drains back the same way.

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11
Q

What is the main difference between open and closed angle glaucoma?

(Epidemiology)

A

Open angle glaucoma occurs in both eyes where as closed angle occurs unilaterally.

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12
Q

Which out of closed or open angle glaucoma is more common?

A

Open angle glaucoma is more common.

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13
Q

Glaucoma causes and increase in IOP. What are the two factors that contribute towards this?

A

Rate of AqH production and outflow resistance both contribute to an increase in IOP.

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14
Q

What is parts of the eye is thought to be damages as a result of primary open angle glaucoma?

A

The optic nerve is thought to be damages due to an increase in IOP caused by obstruction of outflow.

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15
Q

What causes the angle closure in PACG leading to elevation in IOP?

A

Contraction of the dilatory muscle and precipitation of the pupil sphincter caused the closure of this angle.

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16
Q

What IOP values are expressed with open angle and closed angle glaucoma?

A

Open angle - 21mmHg +

Closed angle - 50 -80mmHg

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17
Q

What is the aim of Glaucoma treatment?

A

Reduced IOP as much as possible preventing loss of vision.

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18
Q

What OHT treatment is offered to people with IOP of 24mmHg?

A

These people are offered a Prostaglandin analogue.

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19
Q

If PGA treatment is not tolerated, what is then given ?

A

If PGA treatment is not tolerated a generic PGA is given, followed by a beta blocker, then a non generic PGA, a carbonic anhydrase inhibitor is offered in that order.

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20
Q

In what patient population can all other alternate IOP treatment be used?

A

In patients with IOP greater then 24mmHg or where current treatment isn’t effective, alternate treatment is used.

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21
Q

What clinical steps should be taken when IOP cannot be reduced?

A

These patients should be referred to a specialist / hospital.

22
Q

Should treatment be offered to patients with suspected closed angle glaucoma and IOP less then 24 mmHg?

A

No treatment should not be offered.

23
Q

What treatment is offered to patients with suspected COAG and a IOP greater then 24mmHg?

A

A generic PGA is offered.

24
Q

What treatment is offered to patients with confirmed COAG?

A

A generic PGA is offered to patients.

25
Q

What are the 4 beta blockers used to treat glaucoma?

A

Timolol
Carteolol HCl
Levobunolol HCI
Betaxolol

26
Q

Which of the beta blockers are non selective?

A

Timolol, Carteolol HCl, Levobunolol HCl are non selective blocking the action of both B1 and B2.

27
Q

What is a key difference between Timolol and Carteolol HCl?

A

Carteolol has greater bioavailability and longer duration of action.

28
Q

How is Levobunolol HCl better then both Timolol and Carteolol HCl?

A

It has the longest duration ot action out of the three.

29
Q

Beta Blockers can be 1st generation or 2nd generation what is the difference between there action and what does this result in?

A

2nd generation are B1 selective which means they have reduced effect on B2 receptors with reduced side effects.

30
Q

Give an example of a 2nd generation beta blockers.

A

Practolol is a example of a 2nd generation beta blocker.

31
Q

What is an example of a 3rd generation beta blocker?

How is this formulated to reduce IOP?

A

Betaxolol is an example of a 3rd generation beta blocker and are formulated as eyedrops to reduce IOP.

32
Q

How do 3rd generation beta blockers reduce IOP?

A

They reduce IOP by reducing the formation of AqH this occurs by the inhibition of cAMP.

33
Q

What are the 2 prostaglandin analogues?

A

The 2 prostaglandin analogues are Latanoprost and Bimatoprost.

34
Q

How do prostaglandin analogues reduce IOP in glaucoma?

A

They increase the outflow of AqH via the uveoscleral pathway.

35
Q

What mechanisms causes the increased outflow of AqH caused by PGA?

A

Increased extracellular matric metallproteinases.

Remodeling of uveal meshwork.

Increased bloodflow to optic nerve.

36
Q

How does Bimatoprost differ from Latanoprost?

A

Bimatoprost increases AqH outflow by both the uveoscleral and trabeculuar pathways.

37
Q

Where are carbonic anhydrase enzymes found and how many forms of the enzyme exist?

A

These enzymes are found in ocular tissue and there are 3 forms of this enzyme. (CA-I, CA-II and CA-IV)

38
Q

What does the inhibition of carbonic anhydrase enzymes lead to?

A

Inhibition of this enzyme slows the formation of bicarbonate ions, reducing sodium transport, decreasing AqH production.

39
Q

What do Sympathomimetic drug mimic the effect of?

A

These mimic the effects of the neurotransmitters of the sympathetic nervous system.

40
Q

What adrenoceptors are symapthomimetic drugs selective to?

A

They are selective to alpha2-adrenoreceptors with agonising action.

41
Q

Give 2 examples of adrenergic agonists.

A

Aparaclondine and brimonidine are examples of agonists.

42
Q

How do sympathomimetic drugs reduce IOP?

A

These drugs vasoconstrict the ciliary body reducing AqH production and increasing outflow due to vein dilation.

43
Q

What is the condition dry eyes presented in patients?

A

Having dry eyes causes irritation, discomfort, presented in patients as burning, itching and irritation.

44
Q

What happens to tears to cause dry eyes?

A

Dry eyes are caused by reduction in tear volume and altered tear composition

45
Q

How does a reduction of tear volume in the eye occur?

A

Tear volume reduction occurs due to increased evaporation, tear drainage and reduced tear production.

46
Q

The tear film is made of 3 layers. What are they and what does a reduction in any of these layers result in?

A

Mucin layer
Aqueous layer
Lipid layer
Reduction in any of these causes dryness.

47
Q

What pharmaceutical treatment is used for dry eyes?

A

This condition is managed by the use of artificial tears and lubricating ointments.

48
Q

Why are products used in the management of dry eyes developed with polyvinyl alcohol instead of hypromellose?

A

Polyvinyl alcohol has increased wetting characteristics and requires less frequent dosing.

49
Q

What material can causes infections in the eyes and how are these clinically presented?

A

Infections can be caused by viral and bacterial conjunctivitis and is presented by redness of the eye and sclera.

50
Q

What is the most common form of bacterial eye infection?

A

Most bacterial eye infections are caused by Staphylococcus.

51
Q

What treatment is offered to patients with eye infections?

A

Chloramphenicol is the 1st line treatment and Ciprofloxacin are used in the treatment of infections.

Special Senses (7 decks)

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