Head and Neck > Glaucoma > Flashcards

Glaucoma Flashcards

(48 cards)

Study These Flashcards
1
Q

What is glaucoma?

A

Impaired outflow of aqueous humour from the anterior chamber causes raised intraocular pressure leading to progressive optic neuropathy involving characteristic changes to optic nerve head.

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2
Q

What is glaucoma?

A

Impaired outflow of aqueous humour from the anterior chamber causes raised intraocular pressure leading to progressive optic neuropathy involving characteristic changes to optic nerve head.

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3
Q

Describe the production and flow of aqueous?

A

Aqueous is produced by the ciliary body and flows from the posterior chamber to the anterior chamber through the pupil; drains into the episcleral veins via the trabecular meshwork and the Canal of Schlemm

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4
Q

What is an isolated increase in IOP termed? Mx?

A

Ocular HTN. Should be followed for increased risk of developing glaucoma.

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5
Q

What IOP is more likely to be associated with glaucoma?

A

Pressures >21mmHg more likely to develop glaucoma

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6
Q

Progression of glaucoma development?

A

Gradual pressure rise -> increased C:D ratio -> visual field loss. Loss of peripherals generally precedes loss of central vision.

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7
Q

Ix in glaucoma?

A
  • Hx inc FHx
  • VA testing
  • Slit lamp to assess anterior chamber depth
  • opthalmoscopy to assess disc features
  • Visual field testing
  • Tonometry by application or indentation to measure IOP
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8
Q

What is primary open angle glaucoma?

A

-Most common (>95% cases)
Due to obstruction of aqueous drainage within the trabecular meshwork and its drainage into the canal of Schlemm. Very insidious!!

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9
Q

What is the average IOP?

A

15mmHg +/- 3

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10
Q

What is the normal Cup:Disc ratio?

A
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11
Q

When should glaucoma be suspected in relation to C:D ratio?

A
  • > 0.6
  • C:D ratio b/w eyes >0.2
  • Cup approaches disc margin
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12
Q

What are the RFx for primary open angle glaucoma?

A

A FIAT

  • Age (increased)
  • FHx (2-3x inc risk)
  • IOP (>21mmHg)
  • African descent
  • Thin cornea
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13
Q

Glaucoma bilateral or unilateral?

A

Bilateral but usually asymmetric

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14
Q

What are the optic disc changes in glaucoma?

A
  • Increased C:D ratio / C:D asymmetry >0.2 b/w eyes
  • thinning of neuroretinal rim
  • flame shaped disc haemorrhage
  • 360” peripapillary atrophy
  • nerve fibre layer defect
  • large vessels become nasally displaced
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15
Q

Characteristic visual defects in glaucoma?

A 
Slow peripheral loss of vision
-Paracentral defects
-Arcuate scotoma
-Nasal step
Late loss of central vision if untreated
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16
Q

Medical treatment options in glaucoma management?

A
  • Increase aqueous outflow
  • -> topical cholinergics
  • -> topical PG analogues
  • -> topical a-adrenergics
  • Decrease aqueous production
  • ->topical B blockers
  • -> topica/oral carbonic anhydrase inhibitor
  • -> topical a-adrenergics
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17
Q

Monitoring in glaucoma?

A
  • serial optic nerve head examination
  • IOP measurement
  • visual field testing
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18
Q

Surgical management of glaucoma?

A
  • Laser trabeculoplasty
  • Cyclophotocoagulation (selective destruction of ciliary body)
  • Trabeculectoy
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19
Q

What is primary angle closure glaucoma?

A

PACG 5% glaucoma cases.

  • peripheral iris bows forward in susceptible eye with shallow anterior chamber; obstructs aqueous access to trabecular meshwork.
  • sudden forward shift of lens-iris diaphragm causes pupillary block, inability of aqueous to flow from posterior chamber to anterior chamber –> sudden rise in IOP
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20
Q

RFx PACG?

Study These Flashcards
A
  • Hyperopia: small eye, big lens
  • Age >70
  • Female
  • FHx
  • Asian / Inuit
  • Mature cataracts
  • Shallow anterior chamber
21
Q

Mx primary angle closure glaucoma?

Study These Flashcards
A

BACH

  • B blockers and miotics
  • Adrenergics
  • Cholinergics
  • Hyperosmotic agents
22
Q

CFx PACG?

Study These Flashcards
A
  • Red painful eye
  • Unilateral (but other eye increased risk)
  • Decreased VA
  • Halos around lights
  • N/V/Abdo pain
  • Fixed, mid-dilated pupil
  • Corneal oedema w/ conjunctival injection
  • Marked IOP increase
23
Q

Why does PACG lead to decreased VA?

Study These Flashcards
A

Vision acutely blurred from corneal oedema

24
Q

Mx PACG?

Study These Flashcards
A
  • Refer opthal : EMERGENCY

- Requires laser iridotomy, aqueous suppressants and hyper osmotic agents

25
Mx PACG?
- Refer opthal : EMERGENCY | - Requires laser iridotom, aqueous suppressants and hyper osmotic agents
26
Describe the production and flow of aqueous?
Aqueous is produced by the ciliary body and flows from the posterior chamber to the anterior chamber through the pupil; drains into the episcleral veins via the trabecular meshwork and the Canal of Schlemm
27
What is an isolated increase in IOP termed? Mx?
Ocular HTN. Should be followed for increased risk of developing glaucoma.
28
What IOP is more likely to be associated with glaucoma?
Pressures >21mmHg more likely to develop glaucoma
29
Progression of glaucoma development?
Gradual pressure rise -> increased C:D ratio -> visual field loss. Loss of peripherals generally precedes loss of central vision.
30
Ix in glaucoma?
- Hx inc FHx - VA testing - Slit lamp to assess anterior chamber depth - opthalmoscopy to assess disc features - Visual field testing - Tonometry by application or indentation to measure IOP
31
What is primary open angle glaucoma?
-Most common (>95% cases) Due to obstruction of aqueous drainage within the trabecular meshwork and its drainage into the canal of Schlemm. Very insidious!!
32
What is the average IOP?
15mmHg +/- 3
33
What is the normal Cup:Disc ratio?
N C:D =
34
When should glaucoma be suspected in relation to C:D ratio?
- >0.6 - C:D ratio b/w eyes >0.2 - Cup approaches disc margin
35
What are the RFx for primary open angle glaucoma?
A FIAT - Age (increased) - FHx (2-3x inc risk) - IOP (>21mmHg) - African descent - Thin cornea
36
Glaucoma bilateral or unilateral?
Bilateral but usually asymmetric
37
What are the optic disc changes in glaucoma?
- Increased C:D ratio / C:D asymmetry >0.2 b/w eyes - thinning of neuroretinal rim - flame shaped disc haemorrhage - 360" peripapillary atrophy - nerve fibre layer defect - large vessels become nasally displaced
38
Characteristic visual defects in glaucoma?
``` Slow peripheral loss of vision -Paracentral defects -Arcuate scotoma -Nasal step Late loss of central vision if untreated ```
39
Medical treatment options in glaucoma management?
- Increase aqueous outflow - -> topical cholinergics - -> topical PG analogues - -> topical a-adrenergics - Decrease aqueous production - ->topical B blockers - -> topica/oral carbonic anhydrase inhibitor - -> topical a-adrenergics
40
Monitoring in glaucoma?
- serial optic nerve head examination - IOP measurement - visual field testing
41
Surgical management of glaucoma?
- Laser trabeculoplasty - Cyclophotocoagulation (selective destruction of ciliary body) - Trabeculectoy
42
What is primary angle closure glaucoma?
PACG 5% glaucoma cases. - peripheral iris bows forward in susceptible eye with shallow anterior chamber; obstructs aqueous access to trabecular meshwork. - sudden forward shift of lens-iris diaphragm causes pupillary block, inability of aqueous to flow from posterior chamber to anterior chamber --> sudden rise in IOP
43
RFx PACG?
- Hyperopia: small eye, big lens - Age >70 - Female - FHx - Asian / Inuit - Mature cataracts - Shallow anterior chamber
44
Mx primary angle closure glaucoma?
BACH - B blockers and miotics - Adrenergics - Cholinergics - Hyperosmotic agents
45
CFx PACG?
- Red painful eye - Unilateral (but other eye increased risk) - Decreased VA - Halos around lights - N/V/Abdo pain - Fixed, mid-dilated pupil - Corneal oedema w/ conjunctival injection - Marked IOP increase
46
Why does PACG lead to decreased VA?
Vision acutely blurred from corneal oedema
47
When is increased IOP noticeable even on palpation?
IOP >40mmHg
48
Mx PACG?
- Refer opthal : EMERGENCY | - Requires laser iridotom, aqueous suppressants and hyper osmotic agents
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