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SPM- Opthamology > Glaucoma > Flashcards

Glaucoma Flashcards

1
Q

What is glaucoma?

A

A condition characterised by optic disc cupping and visual field loss, in which the IOP is sufficiently raised to impair normal optic disc function

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2
Q

What is the different between primary and secondary glaucoma?

A

Primary- no cause apparent

Secondary- cause known e.g. trauma

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3
Q

What are the different types of primary glaucoma?

A

Primary open angle glaucoma

Primary acute angle closure glaucoma

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4
Q

What are some causes of secondary glaucoma?

A

Inflammation

Trauma

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5
Q

What is raised IOP?

A

IOP above 21mmHg

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6
Q

How is primary open angle glaucoma defined?

A

IOP>21mmHg (Normal is between 10 and 21)
Open aqueous drainage outflow
Cupping of the optic disc
Visual field loss- peripheral

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7
Q

What is ocular hypertension? How does it differ from glaucoma?

A

Raised IOP (>21mmHg) but no cupping or visual field changes. For it to be glaucoma there must be cupping of the optic disc and visual field loss. Glaucoma can occur with pressures below 21mmHg.

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8
Q

Is IOP constant?

A

No it has diurnal variation, time should be recorded when measuring IOP

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9
Q

What are some risk factors for primary open angle glaucoma?

A 
Increasing age
Steroids
Diabetes
Family history
High myopia- short sighted
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10
Q

What are the symptoms of primary open angle glaucoma?

A

Asymptomatic in most
Never any pain
Can cause loss of peripheral vision which may become noticable

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11
Q

What is used to measure IOP?

A

Goldmann Applanation Tonometer- presses against the eye to measure the pressures

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12
Q

What is seen at the optic disc?

A

Cupping of the optic disc >0.5
Pallor of the optic disc
Asymmetry of the cup to disc ratio

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13
Q

What is a normal cup to disc ratio?

A

Less than 0.3

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14
Q

What is a vascular complication of glaucoma?

A

Central vein occlusion

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15
Q

Describe the visual field loss in glaucoma?

A

Initially nasal step
Then superior and inferior arcuate scotomas
Temporal and central islands
Complete field loss= Blindness

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16
Q

How can visual fields be tested?

A

Goldmann Fields- The one with the big disc thing

Humphrey Fields- Automated, computer shines light and works out visual fields by which lights are detected

17
Q

Why is there often a delay to diagnosis of glaucoma?

A

It is asymptomatic initially

18
Q

How is glaucoma monitored?

A

Monitor IOP, Visual Field Changes, Cupping of the optic disc

19
Q

What are the medical treatments for glaucoma?

A

Topical Eye drops-

  • Prostaglandin analogues (e.g. Latanoprost)- Increase uveo-scleral outflow
  • Beta Blockers (e.g. Timolol)- decrease aqueous production. Not if asthma or COPD.
  • Carbonic Anhydrase Inhbitiors (e.g. dorzolamide) decrease aqeous production
  • Alpha 2 agonists (e.g. Brimonidine) decrease aqeous production and increase uveo-scleral outflow

Systemic (if emergency or temporary drop needed)-
Acetazolomide- Carbonic Anhydrase Inhibitor

20
Q

What topical agents may be used in glaucoma?

A

Prostaglandin analogues
Beta blockers
Carbonic anhydrase inhibitors
Alpha 2 agonists

(add in that order)

21
Q

What is a prostaglandin analogoue example?

A

Latanoprost

22
Q

What is a beta-blocker eye drop used for glaucoma?

A

Timolol

23
Q

What is a topical carbonic anhydrase inhibitor used for glaucoma?

A

Dorzolamide

24
Q

What is an example of a topical alpha 2 agonist used for glaucoma?

A

Brimonidine

25
Q

What surgical options may be used for the treatment of glaucoma?

A

Trabeculectomy- fistula formed between anterior chamber and sub-conjunctival space. Creates a bleb where aqueous can drain

Augmentation- topical chemotherapy (mitomycin C or 5-FU) may be used during surgery to prevent scar formation around the trabeculectomy.

Laser- To trabecular meshwork

Drainage tubes- for more resistant cases

26
Q

What it the treatment for acute angle closure glaucoma?

A

Cycloplegics- to constrict the pupil so that it no longer obstructs the drainage pathway
IV Acetazolomide
Mannitol
YAG Iridotomy

27
Q

What is the first line of treatment for POAG?

A

Prostaglandin analogues- e.g. Lantoprost

Increase aqueous drainage though uveo-scleral route

28
Q

What are some side effects of lantoprost for POAG?

A

Conjunctival hyperaemia

Increased eye lash length and thickness

29
Q

What beta blocker eye drops may be used for POAG? How do they work?

A

Timolol- decrease aqeous production

30
Q

What are some side effects of timolol for POAG?

A

Systemic effects- bradycardia, asthma exacerbation, hypotension

CI- Patients with asthma, COPD and bradycardia

31
Q

How do alpha 2 agonists reduce IOP?

A

Reduce aqeous production

Increase uveo-scleral outflow

32
Q

Give an example of an alpha-2 agonist used for the treatment of POAG

A

Brimonidine

Apraclonidine

33
Q

How do carbonic anhydrase inhibitors?

A

Inhibit carbonic anhydrase and therefore reduce aqueous production. Systemic or oral forms are effective. Systemic treatments for glaucoma are reserved for emergencies only.

34
Q

What are some side effects of acetazolomide?

A 
GI Side effects
Metallic taste in mouth
Lethargy
Diuresis
Potassium loss
Renal stones

SPM- Opthamology (11 decks)

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