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Ophthalmology > Unit 2 - Glaucoma > Flashcards

Unit 2 - Glaucoma Flashcards

1
Q

What are ‘the glaucomas?’

A

a group of diseases characterized by increased intraocular pressure and progressive degeneration of the optic nerve and retina

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2
Q

Why do we care about the glaucomas?

A

Pain and vision loss

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3
Q

What is the pertinent anatomy to glaucoma?

A

Ciliary body

Posterior and anterior chambers

Iridocorneal angle

Pectinate ligaments

Ciliary cleft

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4
Q

What is the normal intraocular pressure of dogs and cats?

A

10-20 mmHg

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5
Q

What is the normal intraocular pressure in horses?

A

15-30 mmHg

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6
Q

What produces aqueous humor?

A

Ciliary body epithelium

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7
Q

What enzyme is in charge of active secretion of aqueous humor from the ciliary body epithelium?

A

Carbonic anhydrase

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8
Q

What is in charge of the outflow of aqueous humor?

A

Iridocorneal angle - trabecular neshwork (conventional) and uveoscleral (non-conventional)

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9
Q

Normal intraocular pressure relies on what?

A

A balance between production and outflow of aqueous humor

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10
Q

Glaucoma is always due to what (physiologic level)?

A

Impaired outflow

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11
Q

The clinical signs of glaucoma vary depending on what?

A

Severity, duration, and cause

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12
Q

What clinical signs are consistent with glaucoma (not chronic)?

A

Decreased to absent vision

Migraine pain

Injected episcleral vessels

Dilated pupil

Diffuse corneal edema

Optic nerve cupping

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13
Q

What clinical signs are consistent with chronic glaucoma?

A

Buphthalmos, Haab’s striae, lens subluxation, and retinal degeneration

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14
Q

What is the preferred tool for diagnosing glaucoma?

A

Tonovet

Other options: Digital (fingers), Schiotz or cotton swab (indentation), and Tonopen

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15
Q

Tonovet uses ______ tonometry and it (does/does not) require topical anesthetic to use. Tonopen uses _____ tonometry and it (does/does not) require topical anesthetic to use.

A

Rebound

Does not

Applanation

Does

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16
Q

You have glaucoma if what two things are occuring?

A

There is elevated IOP and consistent clinical signs

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17
Q

Classify primary glaucoma.

A

Occurs without antecedent ocular disease

Breed-related

Bilateral

Eventually blinding

Treat early to prolong vision and comfort

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18
Q

Classify secondary glaucoma.

A

Sequelae from other intraocular disease

Most common in cats and horses

Unilateral or bilateral

Treat underlying cause for better prognosis

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19
Q

What is the most common form of glaucoma in dogs?

A

Primary

20
Q

What is goniodysgenesis?

A

Iridocorneal angle malformation

21
Q

What is the typical signalment for primary glaucoma?

A

Females are at a greater risk

Average age of onset 6-8 years

22
Q

Secondary glaucoma is a sequelae of what diseases?

A

Uveitis, lens luxation, intraocular neoplasia, and others (hyphema, retinal detachment, intumescent cataract)

23
Q

How does uveitis cause secondary glaucoma?

A

Inflammatory cells clog the drain

Iris bombe is the synechiae

24
Q

What is used to differentiate between primary and secondary glaucoma?

A

Signalment

Ophthalmic examination

Gonioscopy

Histopathology

25
Q

What is gonioscopy?

A

The visualization of the iridocorneal angle using a special lens

26
Q

What are the general principles of glaucoma management?

A

Must recognize the clincal signs

Determine if primary or secondary

Prognosticate vision

Lower IOP as quickly as possible

27
Q

What two questions should you ask yourself in regards to treatment of glaucoma?

A

Is the eye visual or not?

Is the glaucoma primary or secondary

28
Q

‘Is the eye visual or not?’ How would you treat it if it was visual? Not visual?

A

Visual - medical +/- surgical therapies

Non-visual - salvage procedures for end-stage globe

29
Q

‘Is the glaucoma primary or secondary?’ How would you treat if primary? Secondary?

A

Primary - treat affected eye but remember to start prophylactic therapy for contralateral eye

Secondary - treat glaucoma but also underlying cause

30
Q

What is the goal of prophylactic glaucoma therapy of the contralateral eye?

A

Delay the onset of glaucoma by several months

31
Q

What are the options for prophylactive glaucoma treatment?

A

Demecarium bromide - 0.125%

Prednisolone acetate 1%

32
Q

What are the recommended general medications for glaucoma therapy?

A

Carbonic anhydrase inhibitors

Prostaglandin analogs

Beta blockers

Parasympathomimetics

Hyperosmotic agents

33
Q

What are the recommended carbonic anhydrase inhibitors for the treatment of glaucoma?

A

Dorzolamide or brinzolamide BID-QID

34
Q

What are the recommended prostaglandin analogs for the treatment of glaucoma?

A

Latanoprost or travoprost SID-TID

35
Q

What are the recommended beta blockers for the treatment of glaucoma?

A

Timolol BID

36
Q

What are the recommended parasympathomimetics for the treatment of glaucoma?

A

Demecarium bromide

37
Q

What are the recommended hyperosmotic agents (emergency) for the treatment of glaucoma?

A

Mannitol IV or glycerin PO

38
Q

What drugs should not be used for the treatment of glaucoma?

A

Never use dilating agents (atropine or tropicamide)

Timolol - caution in cats and small dogs

No miotic agents (latanoprost, demecarium bromide) if anterior lens luxation

If uveitis - add latanoprost

39
Q

What is the recommended emergency treatment for acute glaucoma?

A

Hyperosmotic agents (mannitol or glycerin) - draws fluid from vitreous

Dorzolamide +/- timolol topical

Aqueocentesis if medications are ineffective (27 or 30 gauge)

40
Q

When should a patient be rechecked after glaucoma diagnosis?

A

1 day, then 1 week, then 1 month

41
Q

T/F: Primary glaucoma is a good long-term prognosis

A

False - poor

42
Q

What are the surgery options for visual glaucoma patients?

A

Diode laser treatment of ciliary body

Gonioimplant to increase AH outflow

Experimental surgeries under investigation

43
Q

What are the glaucoma surgery options for end-stage for irreversibly blind, painful eyes?

A

Enucleation

Evisceration with prosthesis

Chemical ablation

44
Q

T/F: Chemical ablation is just for end-stage glaucoma in dogs

A

True - bad for cats

45
Q

What are important things to let your clients know when their pet has been diagnosed with glaucoma?

A

Poor prognosis

Progression is variable, but slower with therapy

If primary - the contralateral eye will become affected but slower and less severe with prophylactic therapy

Usually results in blindness

Painful IOP not controlled

comfort is a priority

Ophthalmology (13 decks)

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