Glaucoma

Question 1

What is the normal function of the eyes fluid system to keep the eye in shape.

Answer 1

Ciliary body produces aqueous humour which is constantly produced and then travels in between the iris and lens through the pupil into the anterior chamber. Then goes backs out the trabecular mesh work (aka drain)

Question 2

What is primary open angle glaucoma

Answer 2

where the eye’s drainage angle stays open, but the internal drainage system (trabecular meshwork) malfunctions, slowing fluid (aqueous humor) outflow, causing gradual pressure buildup (intraocular pressure)

Question 3

What happens with primary open angle

Answer 3

Elevated intraocular pressure
Changes in optic disk
Changes in visual field

Question 4

Non-pharmacological management of primary open

Answer 4

•Patient education
•Managing visual expectations
•Vision/ VF that has already been lost cannot be restored
•Aim of treatment is to maintain vision / prevent worsening
•Driving advice- need to inform dvla only if both eyes affected

Question 5

More non pharmacological of primary open

Answer 5

Aids – low vision aids, field expanders, long cane as patients usually have tunnel vision (can’t see feet) , non-optical aids
•ECLO- eye clinic officer (gives advice and leaflets)
•CVI- (site impaired)

Question 6

What happens if we don’t stop losing never fibres- slowed or stopped

Answer 6

We can go blind

Question 7

Pharmacological- managment of primary open

Answer 7

Eyedrops to lower intra-ocular pressure:
•Prostaglandins (e.g. latanoprost) - increase aqueous outflow
•Beta-blockers (e.g. timolol) - reduce aqueous production
•Carbonic anhydrase inhibitors (e.g. dorzolamide) - reduce aqueous production
•Adrenergic agonists (e.g. brimonidine) – reduce aqueous production and increase aqueous outflow
•Cholinergic (e.g. pilocarpine) – increases aqueous outflow

Combined therapy and preservative free options

Question 8

Side effects

Question 9

Surgical management of primary open angle

Answer 9

Surgical
•Selective Laser Trabeculoplasty- is a laser treatment for glaucoma that lowers eye pressure by improving fluid drainage from the eye, targeting the trabecular meshwork

•Trabeculectomy
•Deep sclerectomy
•Drainage devices
•Cyclo-diode laser

Question 10

What is ocular hypertension

Answer 10

Risk of glaucoma but haven’t got it yet

• normal disc and field
  -elevated iop higher than normal but every else is fine unlike glaucoma

Question 11

Ocular hypertension managment

Answer 11

Non-pharmacological
•Patient education – OHT is risk for glaucoma, treatment to prevent development to glaucoma by lowering IOP.

Pharmacological
•Prostaglandins eye drops (e.g. latanoprost)

Surgical
•Selective Laser Trabeculoplasty

Question 12

What is acute angle closure glaucoma

Answer 12

ophthalmic emergency causing a sudden, painful spike in eye pressure due to the iris blocking the eye’s drainage angle, leading to rapid optic nerve damage and potential blindness if not treated immediately

Comes on suddenly, rapid loss of sight
Corneal oedema = reversible
Optic nerve damage can occur with prolonged high pressure = irreversible

Ophthalmic Emergency

Question 13

Non pharmalogical of closure glaucoma

Answer 13

Lie flat on back

Question 14

Pharmacological closure

Answer 14

Pharmacological
Immediate:
•Topical Cholinergic (e.g. pilocarpine)
•Oral carbonic anhydrase inhibitors (e.g. acetazolamide)
•Oral analgesia

Later topical anti-hypertensives:
•Prostaglandins (e.g. latanoprost)
•Beta-blockers (e.g. timolol)
•Carbonic anhydrase inhibitors (e.g. dorzolamide)
•Adrenergic agonists (e.g. brimonidine)

Question 15

Surgical managment closure

Answer 15

-Laser peripheral iridotomy
-Later – Lens extraction