Glaucoma

Question 1

What is Fuch’s heterochromic iridocyclitis?

Answer 1

• chronic, non-granulomatous, low-grade anterior uveitis with stellate keratic precipitates
• iris heterochromia (due to chronic inflammation)
• iris/angle neovascularization in affected eye
• risk of glaucoma due to chronic TM damage
• cataracts due to chronic inflammation

Question 2

Conditions associated with Fuch’s heterochromic iridocyclitis?

Answer 2

• ocular toxoplasmosis
• Horner’s CMV
• retinitis pigmentosa
• Herpes simplex
• ocular trauma
• rubella virus

Question 3

Posner-Schlossman syndrome

Glaucomatocyclitic crisis

Answer 3

• acute trabeculitis
• open angle
• elevated IOP (40-60mmHg) resulted in blurred vision
• open angle on gonio
• few cells in anterior chamber
• young to middle-aged patients

Question 4

Pseudoexfoliation syndrome

Answer 4

• age-related systemic condition found in elderly Scandinavian Caucasians
• most common cause of elevated IOP and secondary open angle glaucoma
• due to abnormalities of basement membrane
• accumulation of toxic flaky deposits in various connective tissues through the body (eg. lung, heart, skin)

Ocular signs:

• whitish flaky deposits on pupillary margin, anterior lens capsule, zonules, trabecular meshwork
• deposits on zonules may cause release of pigment from posterior iris = pigment deposit within TM
• zonules weaker = result in phacodonesis, poor dilation

Question 5

Phacolytic glaucoma

Answer 5

• hypermature cataract leaks lens material into AC
• obstruction of outflow in TM
• cells,flare and lens particle present

Question 6

Phacomorphic glaucoma

Answer 6

Crystalline lens thickens and pushes iris forward into angle resulting in angle-closure glaucoma

Question 7

How much posterior synechiae is required for IOP elevation?

Answer 7

360

Question 8

How much peripheral anterior synechiae is required for IOP elevation?

Answer 8

Most cases, 6 or more clock hours is associated.

Question 9

Acute angle closure

Answer 9

• acute and symptomatic elevation in IOP
• usually hyperopes, Asian/ Eskimo, elderly

Symptoms:
- blurred vision, halos around light, eye pain, nausea, and vomiting

Clinical signs:
- closed angle, IOP > 50 mmHg, corneal edema, mid-dilated pupil, cells in the anterior chamber, conj injection

Tx: peripheral iridotomy

Question 10

Chronic angle closure

Answer 10

• asymptomatic mild elevations in IOP
• suspect in occludable angles and PAS
• pigment splotches on TM (aborted PAS)
• progressive optic nerve damage
• VF loss despite low IOP

Question 11

According to OHTS, non-treated OHT patients after 5 years were ___% more likely to develop POAG.

Answer 11

9.6