Glaucoma

Question 1

def. of glaucoma

Answer 1

irreversible and pregressive disease of the optic nerve , char. by optic disc cupping and visual field changes

Question 2

why important

Answer 2

leading cause of irreversible blindness in the world

Question 3

what is glaucoma

Answer 3

not a single diasease, but number of diff. with factors in common

Question 4

only way to reduce chances of blindness from glaucoma

Answer 4

early diagnosis and treatment

Question 5

6 risk factors for glaucoma

Answer 5

1. # 1 is high IOP
2. age
3. fam Hx
4. black
5. diabetes
6. shortsighted

Question 6

what is IOP

Answer 6

balance of production and drainage of fluid

- usually under 21

Question 7

what is fluid flow

Answer 7

made in ciliary body>around lens to ant. chamber> out through trabecular mesh to canal of schlem

Question 8

what is relat. b/w glaucoma and IOP

Answer 8

higher IOP is higher risk, but not necc.

- IOP is neither suff. or necc. for glaucoma

Question 9

what genetic risk

Answer 9

involved, but probably multifactorial

Question 10

what is patho correlate of glaucoma

Answer 10

slow death of retinal ganglion cells and their axons which form the optic nerve

Question 11

3 proposed mechs.

Answer 11

1. mech injury
2. vacular injury
3. exitotoxicity

Question 12

5 important parts of Hx

Answer 12

1. fam Hx
2. ethnic backgroud
3. prior eye problems
4. meds
5. general health
6. alergies

Question 13

what is main Sx of glaucoma

Answer 13

none- often by the time it’s noticed, the damage is done

Question 14

5 key parts of exam to find glaucoma

Answer 14

1. vision
2. IOP
3. anterior chamber angle measurement
4. optic nerve head exam
5. visual field exam

Question 15

what is tested on vision

Answer 15

central distance vision, not reasding

Question 16

6 things to look for in the slit lamp

Answer 16

• cataracts
• prior surgery
• inflammation
• excess piment
• trauma
• peudo efoliation

Question 17

how to look at the angle

Answer 17

gondioscopy - allows us to see open and closed

Question 18

3 parts of fundus exam

Answer 18

1. optic nerve damage
   ‘2. macular degen
2. other retinal problems

Question 19

2 things to look for at the optic nerve

Answer 19

1. structure of the nerve for signs of damage

2. cup to disc ration (should be under 0.6)

Question 20

6 types of optic nerve changes we might see

Answer 20

1. cupping
2. disc assymetry
3. notching
4. excavation
5. disc hemmorage
6. nerve fiber layer defect

Question 21

what is important about visuak field examination

Answer 21

change over time is the critical factor

Question 22

4 typical visual field defects in glaucom

Answer 22

1. arcuate
2. paracentral
3. nasal step
4. constricted field

Question 23

what is target in treatment

Answer 23

maintain a presdetermined level of pressure

Question 24

3 things monitored in follow-up

Answer 24

1. stability if the optins nerve
2. visual field
3. pressure

Question 25

prognosis of acute angle closure

Answer 25

good with rapid treatment, but not if take too long

Question 26

Sx of AAC glaucoma`

Answer 26

1. halos and rrainbows around eye are most common - NV - red eye - blurred central vision

Question 27

signs of AAc

Answer 27

- v. high pressure - conjuntival injection - cloudy cornea - shallow anterior chamber

Question 28

mech if AAC

Answer 28

iris become opposed to the trabecular meshwork preventing aquous outflow

Question 29

AAC risk factors

Answer 29

- hyperopia - age - F>M - familiy - chinese and inuit

Question 30

what does penlight exam show

Answer 30

done on side and shows shadow on the nasal side because of swelling

Question 31

acute MGMT of AAC

Answer 31

emergency - instil anti-glaucoma meds - instil miotic - IV if necc

Question 32

3 classes of treatment for AAC

Answer 32

meds - acutely laser - ASAP srug - only if necc

Question 33

what is definitie mgmt of glausome

Answer 33

punch a hole in the eye with a laser

Question 34

3 precipitating factors for attacke

Answer 34

1. dim illumination 2. stress 3. druga - esp thoe that dilate pupil

Question 35

5 classes of glaucoma meds

Answer 35

1. prostaglandin agonists 2. B-blockers 3. carbonic anhydrase inhibs 4. a-agonists 5. parasympathomimietics AAC 6. hyperosmotics - acute

Question 36

what is gold standard meds

Answer 36

B-blocker - but has same SE as other B blockers

Question 37

mech of carbonic anhydrase inhibs

Answer 37

decrease aqueus production

Question 38

what is laser therapy

Answer 38

laser aimed at trabecular meshwork and the healing causes drainage - don't know why