Anterior Chamber Disorders

Question 1

Open-angle Glaucoma

Answer 1

• Optic neuropathy results in progressive loss of retinal ganglion cell axons.
• Peripheral visual fields lost first, then central vision, then blindness

Question 2

How does open angle glaucoma progress?

Answer 2

Peripheral fields —> Central vision —> Blindness

Question 3

Glaucoma Sequelae

Answer 3

• Slowly progressive irreversible damage to the optic nerve.

- Loss of vision goes unnoticed until severe

Question 4

Primary Open-angle Glaucoma (POAG) Symptoms

Answer 4

• Symptoms are rarely experienced
• No loss of visual acuity as long as central vision is preserved.
• Irreversible

Question 5

How is POAG diagnosed?

Answer 5

• Characteristic nerve damage on fundis exam and elevated intraocular pressures.
• Cupping

Question 6

Cupping

Answer 6

• A cup that is greater than 50% of the vertical disc diameter.
• Glaucoma can cause the cup to enlarge
• Cup gets bigger in a vertical oval type pattern.

Question 7

Optic Cup

Answer 7

• White, cup-like area in the center of the optic disc.
• Normal cup/disc ratio is 1/3
• There is some normal variation here

Question 8

Do all patients with open angle glaucoma have elevated IOP?

Answer 8

No, not all patients with OAG have elevated IOP.

Question 9

IOP > 40. what should you do?

Answer 9

Emergency Referral.

Question 10

IOP 30-40. what should you do?

Answer 10

Urgent referral within 24 hrs.

Question 11

Screening recommendations

Answer 11

• 40-60 yrs w/o risk factors: ever 3-5 yrs.
• Every 1-2 yrs w/ risk factors
• Periodic exams for black men and women btw ages 20-39.

Question 12

Acute Angle-Closure Glaucoma (AACG)

Answer 12

Occurs only with closure of a pre-existing narrow anterior chamber angle.

Question 13

What brings on AACG

Answer 13

Dark theatre, pharmacological Mydriasis, anticholinergenics,

Question 14

AACG symptoms

Answer 14

• Rapid Onset
• Severe eye pain/HA
• Profound visual loss
• May have photophobia
• N/V

Question 15

AACG signs

Answer 15

Conjunctival redness
Corneal edema or cloudiness
Shallow anterior chamber
Mid-dilated pupil not reactive to light

Question 16

Is angle AACG an emergency?

Answer 16

Absolutely.

Question 17

If it will be greater than an hour before AACG pt can be seen, what should be given?

Answer 17

Acetazolamide, Mannitol, glycerol.

- Decrease IOP

Question 18

AACG tx continued

Answer 18

Timolol (Timoptic)
Apraclonidine (Ioponide)
Pilocarpine (Isopo)
One drop of each, one minute apart.

Question 19

Uveitis

Answer 19

• Intraocular inflammation
• Is immunologic in most cases
• Associated with HLA B27

Question 20

Causes of Uveitis

Answer 20

• CMV: Cytomegalovirus (immunocompromised)
• Toxoplasmosis
• Syphillis
• Cat scratch disease
• HSV and HZV

Question 21

Anterior Uveitis

Answer 21

• 4 times more common than posterior.

- May be seen together with panuveitis

Question 22

Anterior Uveitis Symptoms

Answer 22

• Eye pain
• Redness
• May have visual loss

Question 23

Posterior Uveitis S/S

Answer 23

• Usually painless
• Cells seen in vitreous
• Inflammatory lesions on retina and choroid
• Gradual vision loss
• Often Bilateral
• Yellow or pigmented lesions

Question 24

Infectious uveutis tx

Answer 24

• Antiviral or antibiotics

- Glucocorticoids

Question 25

Noninfectious uveitis tx

Answer 25

Anterior: Topical glucocorticoids and dilating drop Posterior: Periocular injection of triamcinolone or systemic corticosteroids.

Question 26

Iritis

Answer 26

- Usually idiopathic - May be autoimmune associated - Blunt trauma, corneal inflammation

Question 27

Iritis is commonly associated with ______?

Answer 27

Uveitis

Question 28

Iritis Presentation

Answer 28

- Deep eye pain - Photophobia - Redness, ciliary flush - Pupillary constriction - Synechiae can form

Question 29

Which type of agent should be given to a patient with iritis?

Answer 29

A cycloplegic agent, but avoid atropine.

Question 30

Complications of Iritis

Answer 30

- Cataracts - Calcifications of cornea - Glaucoma - Uveitis - Blindness

Question 31

Hyphema

Answer 31

- A suspension of red blood cells in the aqueous humor. | - Due to direct trauma to the eyeball

Question 32

grades of hyphema

Answer 32

Grade 1: Less than 1/3 of the chamber Grade 2: 1/3 to 1/2 of the chamber Grade 3: 1/2 to total chamber Grade 4: Total clotted blood "8-ball hyphema"

Question 33

Is hyphema a medical emergency?

Answer 33

Yes. Refer to optho or ER immediately.

Question 34

About 15-20% of people w/ hyphema have further bleeding in ____ to ____ days.

Answer 34

Three to five. Compliance is very important.

Question 35

Hyphema Meds

Answer 35

- 1% atropine may be used. - Steroid drops - Beta blockers if increased IOP. - Cover eye with shield

Question 36

Home instructions for hyphema

Answer 36

- Bedrest with head of bed elevated. - No strenuous activity - No bood thinners - Tylenol can be taken

Question 37

Hypopion

Answer 37

The presence of pus or puslike fluid in the anterior chamber of the eye. Similar to hyphema, but puslike.

Question 38

Cataracts

Answer 38

Opacity of the lens Leading causes of blindness in the world. Easily cured by surgery Complex pathophysiology