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Year 1/2 > Cognition & Senses 2: Glaucoma > Flashcards

Cognition & Senses 2: Glaucoma Flashcards

1
Q

4 common EYE COMPLAINTS by OWNER when GLAUCOMA is present?

A
  1. RED eye
  2. CLOUDY eye
  3. BLIND eye
  4. PAINFUL eye
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2
Q

GLAUCOMA is the MOST COMMON CAUSE for…

it also causes WHAT severe clinical sign?

considered an ____ ____, but prognosis is ___

A

MOST COMMON CAUSE for LOSS OF GLOBE (enucleation)

it also causes BLINDNESS

considered an OPHTHALMIC EMERGENCY, but prognosis is POOR

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3
Q

DEFINITION of GLAUCOMA?

what PROCESS causes this?

A

= a NEURODEGENERATIVE DZ causing IRREVERSIBLE DAMAGE to the OPTIC NERVE at the AXONS of RETINAL GANGLION CELLS

INCREASED INTRAOCULAR PRESSURE CAUSES THIS

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4
Q

ID LESION & DZ PROCESS…

this is PATHOGNOMONIC for…

A

OPTIC DISC CUPPING causing OPTIC NERVE DAMAGE

this is PATHOGNOMONIC for GLAUCOMA

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5
Q

ID LESION

A

NORMAL OPTIC NERVE on FUNDIC EXAM

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6
Q

what SPECIFICALLY produces AQUEOUS HUMOR?
–> what ENZYME catalyzes this reaction to produce it?

where is this located?

A

the CILIARY PROCESSES of the CILIARY BODY make AQUEOUS HUMOR
–> rxn catalyzed by CARBONIC ANHYDRASE

location = behind the BASE of the IRIS

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7
Q

TRUE/FALSE

the CILIARY EPITHELIUM of the CILIARY PROCESSES are made of 2 PIGMENTED layers

A

FALSE, one is PIGMENTED and the OTHER IS NON-PIGMENTED

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8
Q

TWO ROUTES of AQUEOUS HUMOR OUTFLOW?

& describe them
–> 2 arrows for first
–> 3 arrows for second

species differences?

A
  1. CONVENTIONAL OUTFLOW
    –> through the IRIDOCORNEAL ANGLE via space where iris & cornea meet
    –> aqueous humor then enters TRABECULAR MESHWORK (spongy material)
  2. UNCONVENTIONAL OUTFLOW
    –> UVEO-SCLERAL OUTFLOW via AH getting ABSORBED THROUGH FACE OF IRIS
    –> through CILIARY BODY MUSCLES
    –> dispersed through SCLERA & OUT OF EYE

CATS & DOGS mostly CONVENTIONAL, about HALF of HORSES do CONVENTIONAL

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9
Q

what are PECTINATE ligaments?

A

structures that HOLD THE IRIS & CORNEA TOGETHER at the IRIDOCORNEAL ANGLE

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10
Q

in GLAUCOMA, WHAT causes the INCREASED PRESSURE?

** WHAT IS IMPORTANT TO NOTE?

A

AQUEOUS HUMOR is NOT ADEQUATELY DRAINED

** the PRODUCTION of AQUEOUS HUMOR DOES NOT CHANGE

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11
Q

describe the components of the OPHTHALMIC exam & DIAGNOSTIC testing for GLAUCOMA (2)

difference in OUTCOME for ACUTE vs. CHRONIC glaucoma?

A

OPHTHALMIC exam = look at CLINICAL SIGNS

DIAGNOSTIC testing = look at TONOMETRY

difference in outcome?
ACUTE = VISION CAN BE SAVED
CHRONIC = IRREVERSIBLE VISION LOSS

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12
Q

CLINICAL SIGNS of ACUTE GLAUCOMA…

how does PAIN manifest? (overall & 4 signs)

vision changes? (3, two are NORMAL)

eye appearance changes? (3, one is NORMAL)

A

PAIN from HEADACHE causing…
1. VOMITING
2. EPIPHORA
3. BLEPHAROSPASM
4. HEAD-SHYNESS

VISION?
1. can still have NORMAL REFLEXES
2. NORMAL OPTIC DISC
3. MYDRIASIS (dilation)

APPEARANCES?
1. CONJUNCTIVAL/EPISCLERAL INJECTION
2. DIFFUSE CORNEAL EDEMA
3. globe size is NORMAL

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13
Q

CLINICAL SIGNS of CHRONIC GLAUCOMA…

pain?

vision changes? (4)

appearance of eyes? (3)

A

PAIN OFTEN PRESENT

vision changes?
1. NEGATIVE MENACE/PLR/DAZZLE
2. MYDRIASIS
3. OPTIC DISC CUPPING/ATROPHY
4. RETINAL ATROPHY

appearance?
1. CONJUNCTIVAL/EPISCLERAL INJECTIONS
2. DIFFUSE CORNEAL EDEMA
3. BUPHTHALMIA (large eyes)

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14
Q

ID LESION & DURATION in HORSE

A

ACUTE GLAUCOMA

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15
Q

ID LESION & DURATION in HORSE

there’s another SPECIAL lesion here, & define why it happens

A

CHRONIC GLAUCOMA

can see HABB’S STRIAE
–> due to FRACTURE of the DESCEMET’S MEMBRANE, causing AH GETTING INTO STROMA & this appearance

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16
Q

ID LESION & WHY it can occur due to GLAUCOMA

A

LESION = LENS LUXATION

due to BUPHTHALMIA (large eyes) causing RUPTURE of LENS ZONULES

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17
Q

DIAGNOSTICS for GLAUCOMA..

mostly use ____, which measures…

2 types of TOOLS & how they work?

hints: mention what TYPE of tool it is (-TION suffix), one requires TOPICAL ANESTHETIC, list pros & cons for others

A

mostly use TONOMETRY, which measures IOP

2 types?
1. TONOPEN
–> APPLANATION TONOMETRY
–> TIP OF PEN will FLATTEN CORNEAL SURFACE, and DEPENDING ON HOW MUCH PRESSURE it took for IT TO FLATTEN –> IOP
–> REQUIRES TOPICAL ANESTHETIC

  1. TONOVET
    –> REBOUND TONOMETRY
    –> PROS = NO TOPICAL ANESTHETIC NEEDED & CAN USE ON SMALL EYES
    –> CONS = LIMITED POSITIONING & has trouble reading with CORNEAL DZ
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18
Q

how can we get FALSE HIGH IOP from TONOMETRY? (3)

how can we get FALSE LOW IOP from TONOMETRY? (1)

A

FALSE HIGH?
1. putting PRESSURE ON THE JUGULAR

  1. HEAD is BELOW HEART
  2. PRESSING ON GLOBE THROUGH LID

FALSE LOW = from SEDATION

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19
Q

DIURNAL FLUCTUATION..

what does this mean in relation to IOP? & 2 specifics

so WHEN should we give IOP meds?

A

IOP will CHANGE THROUGHOUT THE DAY
1. IOP is HIGHEST IN THE MORNING
2. IOP is LOWEST AT NIGHT

IOP MEDS should be given AT NIGHT to prep for high pressure in AM

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20
Q

GONIOSCOPY..

= what does it aim to do?

A

= aims to VISUALIZE the IRIDOCORNEAL ANGLE to look for EVIDENCE OF GLAUCOMA

21
Q

image on GONIOSCOPY shows…

is this patient AT RISK for GLAUCOMA?

A

image shows CLOSED IRIDOCORNEAL ANGLE

IS AT RISK FOR GLAUCOMA

22
Q

image on GONIOSCOPY shows…

is this patient AT RISK for GLAUCOMA?

A

image shows OPEN IRIDOCORNEAL ANGLE

NOT AT RISK FOR GLAUCOMA

23
Q

on GONIOSCOPY, describe the DIFFERENCE between TOP & BOTTOM image?

what does this mean in terms of DZ?

A

TOP = OPEN IRIDOCORNEAL ANGLE

BOTTOM = loss of PECTINATE LIGAMENTS caused CLOSED IRIDOCORNEAL ANGLE

BOTTOM is AT HIGHER RISK FOR GLAUCOMA

24
Q

PRIMARY glaucoma…

occurs in WHAT species? (1)

how does this occur?

sex predilection?

age of onset?

A

occurs in DOGS ONLY

how does this occur? = from CONGENITAL DEFECT in the AH SYSTEM that affects either its STRUCTURE or FUNCTION

sex predilection = FEMALES > MALES

age of onset = ~6 YEARS

25
Q

GONIODYSGENESIS..

this is a type of ___ ____ that poses a ____ problem

present in WHAT species?

2 types?

A

PRIMARY GLAUCOMA that poses a STRUCTURAL problem

present in DOGS

2 types?
1. PRIMARY CLOSD/NARROW-ANGLE GLAUCOMA = the IRIDOCORNEAL ANGLE is CLOSED/COLLAPSED

  1. PECTINATE LIGAMENT DYSPLASIA = causes ANGLE TO be OCCLUDED BY A SHEET once ligaments collapse
26
Q

ID DZ (2 terms) & DIFFERENCE between TOP & BOTTOM

A

GONIODYSGENESIS from PECTINATE LIGAMENT DYSPLASIA

TOP = NORMAL

BOTTOM = DZ

27
Q

PRIMARY OPEN-ANGLE GLAUCOMA…

this is a ___ GLAUCOMA that poses a ___ problem

= what occurs?

unilateral vs. bilateral?

A

this is a PRIMARY GLAUCOMA that poses a FUNCTIONAL problem

= there’s RESISTANCE against AH OUTFLOW causing IOP INCREASE & GLAUCOMA

always has a RISK of BEING BILATERAL, but can PRESENT CLINICALLY w/ ONE EYE FIRST

28
Q

5 BREEDS predisposed to PRIMARY CLOSED/NARROW-ANGLE GLAUCOMA?

which is MOST COMMON?

A
  1. AMERICAN COCKER SPANIEL –> MOST COMMON
  2. BOSTON TERRIER
  3. CHOW CHOW
  4. SHAR-PEI
  5. SHIBA-INU
29
Q

4 BREEDS predisposed to PECTINATE LIGAMENT DYSPLASIA?

which 2 are MOST COMMON?

A
  1. BASSETT HOUND –> MOST COMMON
  2. SIBERIAN HUSKY –> MOST COMMON
  3. FLAT-COATED RETRIEVER
  4. SAMOYED
30
Q

TRUE/FALSE

PRIMARY GLAUCOMA caused by FUNCTIONAL FAILURE can be DISTILLED DOWN to a MONOGENIC MUTATION, but STRUCTURAL FAILURE is POLYGENIC

A

TRUE

31
Q

5 BREEDS predisposed to PRIMARY OPEN-ANGLE GLAUCOMA?

A
  1. BEAGLE
  2. NORWEGIAN ELKHOUND
  3. BASSETT HOUND
  4. BASSET FAUVE DE BRETAGNE
  5. PETIT BASSET GRIFFON VENDEEN
32
Q

how can we DIAGNOSE SECONDARY glaucoma? (2)

do we have to do both?

A
  1. there is EVIDENCE of UNDERLYING OCULAR CONDITIONS

+/- –> WE DO NOT HAVE TO DO BOTH!

  1. we have RULED OUT PRIMARY GLAUCOMA
33
Q

what 3 species can get SECONDARY glaucoma?

A

DOGS, CATS, HORSES

34
Q

ANTERIOR UVEITIS..

= definition

2 clinical signs?

how can this cause GLAUCOMA? (2)

A

= INFLAMMATION in ANTERIOR UVEAL TRACT

2 clinical signs?
1. AQUEOUS FLARE
2. MIOSIS

can cause GLAUCOMA by…
1. WBCs or PROTEINS BLOCKING IRIDOCORNEAL ANGLE
2. or PUPIL STICKING TO LENS via SYNECHIA & blocking drainage

35
Q

if we have SECONDARY GLAUCOMA caused by ANTERIOR UVEITIS..

what is the treatment?

what should we NOT use for treatment?
–> why?

A

tx = MANAGEMENT for both GLAUCOMA & UVEITIS

DO NOT USE ATROPINE
–> if we cause MYDRIASIS (dilation of pupil) while the EYE HAS INCREASED PRESSURE, then can CROWD & BLOCK IRIDOCORNEAL ANGLE

36
Q

ANTERIOR LENS LUXATION..

can be both a ____ & ____ of ____

it will cause WHAT clinical change rapidly?

tx?

A

can be both a CAUSE & EFFECT of GLAUCOMA

it will cause RAPID INCREASE in IOP

tx? = must be EMERGENCY Tx & SURGERY to USUALLY REMOVE LENS

37
Q

do we HAVE to perform ENUCLEATION with dogs with INTRAOCULAR NEOPLASIA?

A

NOT UNLESS the MASS is causing INCREASED PRESSURE/GLAUCOMA

38
Q

CONGENITAL GLAUCOMA…

= etiology?

IOP?

what is the CLINICAL FINDING upon BIRTH?

A

= from ANTERIOR SEGMENT DYSGENESIS where NO DRAINAGE PATHWAY FOR AH

IOP will be NORMAL or HIGH

upon BIRTH, see BUPHTHALMIA

39
Q

MEDICAL means of REDUCING AH PRODUCTION to REDUCE GLAUCOMA PRESSURE?

–> include HOW IT WORKS & SPECIFIC DRUGS

which is MOST COMMONLY used?

A
  1. CARBONIC ANHYDRASE INHIBITORS = most COMMON
    –> inhibits carbonic anhydrase to MAKE AH
    –> TOPICAL = DORZOLAMIDE (more common) or BRINZOLAMIDE
  2. BETA-BLOCKER
    –> INHIBITS BETA RECEPTORS on CILIARY EPITHELIUM to MAKE AH
    –> TIMOLOL
40
Q

LATANOPROST…

what KIND of drug is it?

what is the GOAL of this drug?

how does it WORK?

WHEN should it be used?

1 side effect?

what 2 species are CONTRAINDICATED?

A

PROSTAGLANDIN ANALOGUE

GOAL = INCREASE AH OUTFLOW and DECREASE IOP from GLAUCOMA

how does it work? = INCREASES UVEO-SCLERAL OUTFLOW

should be used in ACUTE IOP SPIKES

1 side effect = MIOSIS

2 species CONTRAINDICATED?
1. CATS
2. HORSES
(do not have PROSTAGLANDIN receptors)

41
Q

we DO NOT USE MIOTICS anymore, so INSTEAD we use…

A

PROSTAGLANDIN ANALOGUES

42
Q

when should we NOT USE PROSTAGLANDIN ANALOGUES?

why? (2)

A

when there’s ANTERIOR LENS LUXATION

why?
1. risk of TRAPPING LENS
2. can cause MIOSIS OF PUPIL

43
Q

SURGICAL MANAGEMENT for GLAUCOMA…

2 procedures if we want to SAVE VISION?

1 procedure if we want to SAVE THE GLOBE?

1 procedure if we want to PRESERVE COMFORT?

A

VISION?
1. CYCLOABLATION
2. ANTERIOR CHAMBER SHUNT

GLOBE? = CYCLOABLATION

COMFORT? = ENUCLEATION

44
Q

CYCLOABLATION/CYCLOPHOTOCOAGULATION

the GOAL is to SAVE the ___ of the eye in ___

= what is this procedure?

2 routes of administration?
–> which is MORE COMMON/why?

A

the GOAL is to SAVE the VISION of the eye in GLAUCOMA

= we can DESTROY CILIARY EPITHELIUM in the PIGMENTED LAYER via a LASER to DECREASE AQUEOUS PRODUCTION

2 routes?
1. TRANSSCLERAL = EXTRAOCULAR Sx where laser is APPLIED THROUGH SCLERA, INDIRECT visualization of target
–> MORE COMMON bc LESS INVASIVE

  1. ENDOSCOPIC = INTRAOCULAR Sx where LASER DIRECTLY VISUALIZES TARGET
45
Q

ANTERIOR CHAMBER SHUNT..

the GOAL is to SAVE the ___ of the eye in ___

= what is this procedure?

prognosis post-op?

A

the GOAL is to SAVE the VISION of the eye in GLAUCOMA

= creating a TUBING into ANTERIOR CHAMBER to INCREASE AH OUTFLOW upon INCREASED IOP

prognosis = 50% OF PATIENTS LOSE VISION, NOT GREAT

46
Q

ABLATION of the CILIARY BODY…

GOAL of this surgery?

2 types & how they work?

1 pro?

3 cons?

A

GOAL = to SHUT DOWN PRODUCTION of AH

2 types?
1. CHEMICAL ablation = INTRAVITREAL GENTAMICIN INJECTION
2. CRYO ablation = TRANSSCLERAL APPLICATION of CRYO PROBE

1 pro = SHORT ANESTHESIA TIME

3 cons?
1. UNPREDICTABLE results
2. can REQUIRE REPEAT
3. can result in PHTHISIS BULBI

47
Q

4 options for EMERGENCY GLAUCOMA Tx?

what should we do AFTER giving FIRST 2?

A
  1. LATANOPROST = check for DECREASED IOP in 1 HR
  2. MANNITOL = recheck IOP in 30-60 MINS
  3. ANTERIOR CHAMBER PARACENTESIS (use a needle to remove AH from anterior chamber)
  4. DORZOLAMIDE + TIMOLOL
48
Q

what does MANNITOL do for ACUTE GLAUCOMA

A

can DEHYDRATE THE EYEBALL to help DECREASE IOP

49
Q
A

Year 1/2 (139 decks)

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