Acute glaucoma/Acute angle closure glaucoma Flashcards
What is the incidence of Acute Angle-Closure Glaucoma?
1 - 1 cases per 100,000
2 - 10 cases per 100,000
3 - 100 cases per 100,000
4 - 1000 cases per 100,000
2 - 10 cases per 100,000
What age does Acute Angle-Closure Glaucoma incidence peak at?
1 - 40
2 - 50
3 - 60
4 - 70
4 - 70
Age is a risk factor for developing Acute Angle-Closure Glaucoma
Is Acute Angle-Closure Glaucoma more common in men or women?
- women
- 3:1
Is Acute Angle-Closure Glaucoma more common in asians or caucasians?
- asians
Order the following of normal aqueous flow in anterior chamber:
1 - aqueous circulates in the anterior chamber and drains in the trabecular meshwork
2 - aqueous is produced by the ciliary body behind the iris
3 - aqueous flows behind the iris into the anterior chamber via the pupil
2 - aqueous is produced by the ciliary body behind the iris
3 - aqueous flows behind the iris into the anterior chamber via the pupil
1 - aqueous circulates in the anterior chamber and drains in the trabecular meshwork
In normal anatomy there is a open angle between the iris and cornea in the anterior chamber of the eye. In acute angle closure glaucoma, there is a relative pupil block, meaning aqueous cannot pass through the pupil. This can lead to increased intraocular pressure increases causing the iris to bulge and push forward, resulting in acute angle closure glaucoma. This stops aqueous humour from draining into where?
1 - lower punctum
2 - inferior lacrimal canal
3 - trabecular meshwork
4 - lacrimal sac
3 - trabecular meshwork
Typically the pressure is greatest in the posterior chamber, which further pushes the iris to block the trabecular meshwork
Which of the following anatomical features is NOT associated with increasing the risk of Acute Angle-Closure Glaucoma?
1 - shallow anterior chamber
2 - narrow iridocorneal angle
3 - thin lens
4 - thick peripheral iris
5 - small eyes
3 - thin lens
shallow anterior chamber and small eyes are common in hypermetropia (long sighted) = means it can fill quicker
iridocorneal angle = just means harder for aqueous fluid to drain into trabecular network
Which of the following is NOT a risk factor for developing acute angle closure glaucoma?
1 - hypermetropia (long sighted)
2 - cataract
3 - family history of acute angle closure glaucoma
4 - contact lens wearer
4 - contact lens wearer
Which of the following can lead to Acute Angle-Closure Glaucoma?
1 - Plateau iris syndrome (PIS)
2 - Malignant glaucoma
3 - Neovascular glaucoma
4 - Lens-related causes (phacomorphic glaucoma)
5 - uveitis
6 - all of the above
6 - all of the above
Essentially anything that leads to obstruction of the trabecular matrix
PIS = anteriorly positioned ciliary body and a flat iris plane. Peripheral iris bunches up and occludes the trabecular meshwork despite the presence of a patent iridotomy.
Malignant glaucoma = rare form due to the posterior misdirection of aqueous humour into or behind the vitreous, resulting in an anteriorly displaced lens-iris diaphragm and subsequent angle closure.
Which of the following medications is NOT associated with increasing the risk of developing Acute Angle-Closure Glaucoma?
1 - Adrenergic medications (e.g., noradrenaline)
2 - Anticholinergic medications (e.g., oxybutynin and solifenacin)
3 - Tricyclic antidepressants (e.g., amitriptyline)
4 - NSAIDs
4 - NSAIDs
All the others have anti-cholinergic effects, inhibiting parasympathetic nerve impulses. Can cause dilation of the pupil and cause pupillary block if you already have a narrow angles
Do patients with Acute Angle-Closure Glaucoma typically present with or without pain?
- with severe pain
Often includes a headache
Is visual acuity affected in Acute Angle-Closure Glaucoma?
- yes
There is decreased visual acuity
Patients with Acute Angle-Closure Glaucoma can have nausea and vomiting, why is this?
1 - increased pressure on the vomiting centre
2 - infection
3 - pressure and swelling in the eye
4 - all of the above
3 - pressure and swelling in the eye
Acute Angle-Closure Glaucoma can cause all of the following symptoms in patients, EXCEPT which one?
1 - symptoms worse with mydriasis (e.g. watching TV in a dark room)
2 - hard, red-eye
3 - haloes around lights
4 - fully dilated but reactive pupils
5 - corneal oedema results in dull or hazy cornea
4 - fully dilated but reactive pupils
Patients pupils typically become semi-dilated and are non-reactive as they are blocked
Eyes are not typically hard, so if they are suggests increased intraoccular pressure
Do patients with Acute Angle-Closure Glaucoma typically have systemic symptoms, such as nausea and vomiting and even abdominal pain?
- yes
Most likely due to the severity of the pain
If there is a delay in an ambulance or admission with life threatening red eye, which of the following should be done to manage the patient?
1 - lying the patient on their back without a pillow
2 - Pilocarpine eye drops (2% for blue and 4% for brown eyes)
3 - Acetazolamide 500 mg orally
4 - Analgesia and an antiemetic, if required
5 - all of the above
5 - all of the above
Pilocarpine = muscarinic agonist that contracts pupils and improves visual acuity
Acetazolamide and Dorzolamide = carbonic anhydrase inhibitor reduces aqueous humour
What is the definitive treatment for Acute Angle-Closure Glaucoma?
1 - lifelong treatment with ilocarpine eye drops, Acetazolamide and Brimonidine
2 - laser iridotomy
3 - lens replacement
4 - irisotomy
2 - laser iridotomy
Essentially a hole in the iris will be created, allow aqueous humour to flow and drain
