Gluacoma

Question 1

What special investigation allows a view of the iridocorneal angle?

Answer 1

Gonioscopy

Question 2

What would you see on gonioscopy on a patient with open angle glaucoma?

Answer 2

The trabecular meshwork would appear normal but functionally there is an increased resistance to the drainage of the fluid and causing an elevated occular pressure.

Question 3

Who gets closed angle glaucoma?

Answer 3

Hypermetropic (Long sighted)

Question 4

What might people experience in the weeks before a closed angle gluacoma?

Answer 4

Coloured halos around bright lights

Headaches

Question 5

What is meant by secondary glaucoma?

Answer 5

Blockage of the trabecular meshwork by:

1. Blood due to blunt trauma
2. Uveitis
3. Pigment from the iris
4. Steroids increase the resistance of the meshwork and may cause glaucoma
5. Trauma may directly damage the trabecular meshwork and impair drainage
6. Choriodal melanoma
7. Cataracts may swell and push the iris forward, closing the drainage angle

Question 6

What are the signs and symptoms of a chronic open angle glaucoma?

Answer 6

Usually symptomless in the early stages
White eye and clear cornea
Raised intraocular pressure
Visual field defect 
Cupped op-tic disc

Question 7

What is the visual field defect in glaucoma?

Answer 7

An upper arcuate scotoma

Question 8

What is the usual first line treatment for open angle glaucoma?

Answer 8

Prostoglandin analogues (eg latanoprost)
if this isn't tolerated then a beta blocker is second line followed by a carbonic anhydrase inhibitor

Question 9

How to prostoglandin analgoues work?

Answer 9

Increaing the passage of aqueous through the uveoscleral pathway

Question 10

How do beta blockers work in gluacoma?

Answer 10

Supressing aqueous secretion

Question 11

How do carbonic anhydrase inhibitors work?

Answer 11

Decreasing aqueous secretion

Question 12

What are some of the risks of IV acetazolamide treatment?

Answer 12

Tingling in the limbs

Stevn Johnson syndrome

Question 13

how does pilocarpine work in glaucoma?

Answer 13

Increased outflow

Question 14

if medication does not work in open angle glaucoma then what are the other options?

Answer 14

Laser trabeculoplasty 
Surgical treatment (Trabeculotomy)  which involves creating a fistula between the anteior chamber and the subconjuntival space.

Question 15

What do you see on examination of someone with acute angle closure glaucoma?

Answer 15

Reduces visual acuity 
Red eye
Pain 
Cloudy cornea
Fixed and mid dilated pupul

Question 16

What is the treatment for acute angle closure glaucoma?

Answer 16

Acetazolamide (IV and oral)
Pilocarpine (Topical)
Beta blocker (Topical)