pacg

Question 1

What is another name for Primary Angle Closure Glaucoma?

Answer 1

Acute Congestive Glaucoma

This condition involves the closure of the angle, leading to increased intraocular pressure.

Question 2

What age group is most commonly affected by Primary Angle Closure Glaucoma?

Answer 2

60-70 years

This demographic is particularly susceptible to this condition.

Question 3

What is the mechanism of Relative pupillary block in Primary Angle Closure Glaucoma?

Answer 3

• Apposition of pupillary margin against lens surface
• Aqueous cannot flow from PC to AC
• Pushing effect due to increased pressure in PC

This mechanism leads to increased intraocular pressure.

Question 4

What is Iris Bombe?

Answer 4

Anterior bowing of iris

This condition can contribute to angle closure.

Question 5

What does ITC stand for in the context of angle closure glaucoma?

Answer 5

Iris Trabecular Contact

Persistent ITC can lead to complications in angle closure glaucoma.

Question 6

What are Peripheral anterior synechiae (PAS)?

Answer 6

Iris adhesion with cornea and trabecular meshwork

This condition disrupts the inflow from the posterior chamber to the anterior chamber.

Question 7

List the risk factors for Primary Angle Closure Glaucoma.

Answer 7

• Shallow anterior chamber
• Hypermetropia leading to small anterior chamber
• Females having smaller anterior chambers
• Plateau iris
• Small cornea with increased curvature

These factors increase the likelihood of iris opposing the cornea.

Question 8

What can precipitate angle closure?

Answer 8

Dim light

Situations like being in a movie theatre can cause the iris to move towards the angle.

Question 9

What does PACS stand for in the classification of angle closure glaucoma?

Answer 9

Angle closure suspect

This classification indicates a potential risk for developing angle closure.

Question 10

What is the intraocular pressure (IOP) status in PAC?

Answer 10

Raised

This indicates the presence of primary angle closure.

Question 11

What is the visual field (VF) status in PACG?

Answer 11

Abnormal

This indicates significant damage due to primary angle closure glaucoma.

Question 12

What are the acute symptoms of Primary Angle Closure Glaucoma (PACG)?

Answer 12

• Diminution of vision
• Redness
• Severe pain
• Headache
• Vomiting
• Coloured halos around lights

These symptoms present acutely and indicate a serious condition.

Question 13

What is the IOP measurement that indicates severe pain in PACG?

Answer 13

> 40 mmHg

This high intraocular pressure is a critical sign of PACG.

Question 14

What are the slit lamp findings in PACG?

Answer 14

• Congestion hyperemia
• Hazy cornea
• Corneal edema
• Vogt triad ( iris atrophy + ant sub-cap opacities , post synechiae
• pupillary findings ( vertically oval , dilated and fixed )
• visual field defect
• od changes

These findings help in diagnosing PACG.

Question 15

What is Vogt’s triad in the context of PACG?

Answer 15

• iris atrophy
• ant capsular opacities (glaukomflecken cat)
• Pupillary findings

Vogt’s triad includes specific signs associated with PACG.

Question 16

What are the pupillary findings in PACG?

Answer 16

• Vertically oval pupil (due to iris atrophy)
• Mid dilated pupil (due to atrophy of sphincter pupillae)
• Fixed pupil (neither constricting nor dilating due to posterior synechiae)

These findings indicate the effects of pressure on the eye.

Question 17

What are the visual field changes in PACG?

Answer 17

• Acute: Superior field constriction
• Chronic: Central nasal step

These changes reflect the progression of the disease.

Question 18

What are the optic disc changes associated with PACG?

Answer 18

• Same as in open-angle glaucoma
• Not visualized due to anterior chamber changes (hazy cornea)

The optic disc changes are similar but may not be observable in acute cases.

Question 19

What is the first step in the acute management of PACG?

Answer 19

• Reduce IOP

This is critical to alleviate symptoms and prevent further damage.

Question 20

What is the drug of choice (DOC) for acute episodes of PACG?

Answer 20

IV mannitol (25%: 1.2 g/kg over 30 min)

Mannitol is effective for rapid reduction of intraocular pressure.

Question 21

What is the role of Pilocarpine in PACG treatment?

Answer 21

• Miosis (constricts pupil)
• Ineffective before IOP normalizes

Pilocarpine cannot be used until the pressure is controlled.

Question 22

What should be assessed after initial treatment in PACG?

Answer 22

• Corneal clarity

This assessment helps determine the next steps in management.

Question 23

What is the preferred procedure for glaucoma treatment over open iridectomy?

Answer 23

Laser iridotomy

It is the treatment of choice for prophylaxis of angle-closure glaucoma (PACG).

Question 24

What laser is used in laser iridotomy and what is its wavelength?

Answer 24

Nd: Yag laser, 1064 nm

This laser is used for photodisruption to create a hole in the iris.

Question 25

What is created during a **laser iridotomy**?

Answer 25

A hole in the iris ## Footnote The hole is created between 11 o'clock and 1 o'clock, with the iridotomy hole at 12 o'clock.

Question 26

What condition does **laser iridotomy** help to resolve?

Answer 26

* Intraocular pressure (IOP) * Iris bombae ## Footnote It enables aqueous inflow and prevents diplopia.

Question 27

What is the **treatment** for absolute glaucoma?

Answer 27

Diode laser cyclophotocoagulation ## Footnote This procedure is used for pain relief in blind, painful eyes.

Question 28

What is the **post-surgery management** for mild intraocular pressure?

Answer 28

Latanoprost ## Footnote It is used if intraocular pressure is present at 10-15 mmHg.

Question 29

True or false: **Laser iridotomy** prevents monocular diplopia.

Answer 29

TRUE ## Footnote The iridotomy hole at 10 o'clock is not covered by eyelid, which helps prevent diplopia.