What special investigation allows a view of the iridocorneal angle?
What would you see on gonioscopy on a patient with open angle glaucoma?
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.
Who gets closed angle glaucoma?
Hypermetropic (Long sighted)
What might people experience in the weeks before a closed angle gluacoma?
Coloured halos around bright lights
What is meant by secondary glaucoma?
Blockage of the trabecular meshwork by:
- Blood due to blunt trauma
- Pigment from the iris
- Steroids increase the resistance of the meshwork and may cause glaucoma
- Trauma may directly damage the trabecular meshwork and impair drainage
- Choriodal melanoma
- Cataracts may swell and push the iris forward, closing the drainage angle
What are the signs and symptoms of a chronic open angle glaucoma?
Usually symptomless in the early stages White eye and clear cornea Raised intraocular pressure Visual field defect Cupped op-tic disc
What is the visual field defect in glaucoma?
An upper arcuate scotoma
What is the usual first line treatment for open angle glaucoma?
Prostoglandin analogues (eg latanoprost) if this isn't tolerated then a beta blocker is second line followed by a carbonic anhydrase inhibitor
How to prostoglandin analgoues work?
Increaing the passage of aqueous through the uveoscleral pathway
How do beta blockers work in gluacoma?
Supressing aqueous secretion
How do carbonic anhydrase inhibitors work?
Decreasing aqueous secretion
What are some of the risks of IV acetazolamide treatment?
Tingling in the limbs
Stevn Johnson syndrome
how does pilocarpine work in glaucoma?
if medication does not work in open angle glaucoma then what are the other options?
Laser trabeculoplasty Surgical treatment (Trabeculotomy) which involves creating a fistula between the anteior chamber and the subconjuntival space.
What do you see on examination of someone with acute angle closure glaucoma?
Reduces visual acuity Red eye Pain Cloudy cornea Fixed and mid dilated pupul
What is the treatment for acute angle closure glaucoma?
Acetazolamide (IV and oral)
Beta blocker (Topical)