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Module 8 Glaucoma & Neurophthalmology > Glaucoma > Flashcards

Glaucoma Flashcards

1
Q

Where is aqueous produced?

Which enzyme allows for active secretion of aqueous?

What is the formula for this? And how does this work?

A

Non pigmented epithelium of the ciliary body

Carbonic anhydrase

(Formula in photo)
Movement of bicarbonate ions into the posterior chamber creates osmotic gradient, drawing in water from ciliary stromal vasculature

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2
Q

In regards to aqueous drainage, where does conventional drainage occur?
And unconventional drainage?
Which is the main drainage?

A

Conventional drainage (main) iridocorneal angle

Unconventional drainage (minor) uveoscleral outflow

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3
Q

Does IOP increase or decrease with age?

A

Decrease

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4
Q

Does GA increase or decrease IOP?

A

Decrease

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5
Q

What are the major structures of the drainage apparatus (trabecular mesh work) for aqueous?

A

Trabecular meshwork- pectinate ligament + ciliary cleft

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6
Q

Why does mydriasis occur in glaucoma?

A

Pressure induced paresis/ paralysis of the iris sphincter.

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7
Q

Why does corneal oedema happen in glaucoma?

A

High IOP interferes with the corneal endothelial pump (normally moving water out of the corneal stroma) and then excess water disrupts the stromal lamellae

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8
Q

Is the third eyelid likely to be up or down in globe enlargement?
In exophthalmos?

A

Globe enlargement- down

Exopthalmos - up

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9
Q

What are descemets fractures/ Haabs striae pathopneumonic for?

A

Chronic glaucoma

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10
Q

Why can glaucoma cause lens luxation?

A

Globe enlarge can cause stretching and tearing of the zonular fibres, loosening the lens

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11
Q

In general does primary lens subluxation cause the aphachic crescent to go ventro laterally or dorsally?
And in secondary lens luxation?

A

Primary- dorsal

Secondary- ventrolaterally

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12
Q

What happens to the optic disc when there is glaucoma?

A

Cupping- bows backwards

Then optic nerve head atrophy

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13
Q

What happens during glaucoma to the -retina?
-retinal vessels?

Are these effects reversible?

A

Retina- thinning causing hyper reflectivity
Retinal vessels- attenuated

No- not reversible!

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14
Q

What are equatorial staphylomas caused by?

A

Glaucoma- scleral thinning and stretching.

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15
Q

Pressure induced atrophy of what can cause a normal pressure in a glaucomatous eye?

A

Ciliary processes

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16
Q

Is the Norwegian Elkhound predisposed to
A) pectinate ligament abnormality/goniodysgenesis
OR
B) open angle glaucoma

A

B

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17
Q

Is the flat coat retriever predisposed to
A) pectinate ligament abnormality/goniodysgenesis
OR
B) open angle glaucoma

A

A

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18
Q

Is the Petit Basset Griffon Vendeen predisposed to
A) pectinate ligament abnormality/goniodysgenesis
OR
B) open angle glaucoma

A

B

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19
Q

Is the Fauve de Betagne predisposed to
A) pectinate ligament abnormality/goniodysgenesis
OR
B) open angle glaucoma

A

B

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20
Q

Is the Basset Hound predisposed to
A) pectinate ligament abnormality/goniodysgenesis
OR
B) open angle glaucoma

A

A & B!!

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21
Q

Is the English & Welsh Springer, and English cocker spaniel predisposed to
A) pectinate ligament abnormality/goniodysgenesis
OR
B) open angle glaucoma

A

A

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22
Q

Is the Siberian Husky predisposed to
A) pectinate ligament abnormality/goniodysgenesis
OR
B) open angle glaucoma

A

A

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23
Q

Is the Welsh Terrier predisposed to
A) pectinate ligament abnormality/goniodysgenesis
OR
B) open angle glaucoma

A

A

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24
Q

Is the Great Dane predisposed to
A) pectinate ligament abnormality/goniodysgenesis
OR
B) open angle glaucoma

A

A

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25
Q

Is the Hungarian Viszla predisposed to
A) pectinate ligament abnormality/goniodysgenesis
OR
B) open angle glaucoma

A

A

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26
Q

Is the Dandie Dinmont predisposed to
A) pectinate ligament abnormality/goniodysgenesis
OR
B) open angle glaucoma

A

A

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27
Q

Is the Border Collie predisposed to
A) pectinate ligament abnormality/goniodysgenesis
OR
B) open angle glaucoma

A

A

28
Q

Is gonioscopy useful in open angle glaucoma?

A

No (drainage angle is normal)

29
Q

Is pectinate ligament abnormality/goniodysgenesis congenital or acquired?

A

Congenital

30
Q

What is the main breed for primary lens luxation?

A

Terriers

Occasionally Border collie

31
Q

Is it more common to get glaucoma with an anterior or posterior lens luxation?

A

Anterior

32
Q

In uveitis the iris can become swollen causing glaucoma because it blocks what?

A

The drainage angle

33
Q

What are the most common intraocular neoplasias? (3)

A

Uveal melanoma
Lymphoma
Primary ciliary body adenoma/ adenocarcinoma

34
Q

What breed gets ocular Melanosis/ pigmentary glaucoma?
What age bracket?
Is there any tx to halt the pigment?

A

Cairn terriers
Middle- old age
No

35
Q

What is more effective in cats with glaucoma?
Dorzolamide (trusopt)
Brinzolamide (azopt)

A

Dorzolamide (trusopt)

36
Q

What is a possible side effect of Dorzolamide (trusopt) in cats?

A

Hypokalaemia

37
Q

Which one stings less?

  • Dorzolamide (trusopt)
  • brinzolamide (azopt)
A

Dorzolamide (trusopt)

38
Q

What should be frequency of CAI (Dorzolamide, trusopt and brinzolamide, azopt) in;

  • dogs
  • cats
A

Dogs q6-8h

Cats q12h

39
Q

What % can CAIs reduce IOP by?

A

50%

40
Q

How do prostaglandin analogues increase outflow?

A

Unconventional (uveoscleral outflow)

41
Q

When are prostaglandin analogues contraindicated? (2)

A

Uveitis

Lens luxation

42
Q

In acute management of glaucoma how often and how many times can you use prostaglandin analogues?

A

q15mins for 4-6 doses

43
Q

How often do you give prostaglandin analogues for chronic management?
Latanoprost (Xalatan)
Travaprost (travatan)

A

SID

44
Q

How beta adrenergic blockers work in glaucoma?

A

Decrease aqueous production

May increase outflow too

45
Q

When is Betoxalol, a beta adrenergic blocker, useful?

A

Delaying the development of glaucoma in cases of PLA/ goniodysgenesis

46
Q

How often is cosopt (Dorzolamide and timolol) given?

A

q12h

47
Q

What is the process of cyclocryoablation?

How does it treat glaucoma?

A

Destroys ciliary processes and ciliary epithelium via freezing

Decreasing aqueous humour formation

48
Q

What happens to the IOP immediately post surgery?

A

Increases

49
Q

For how long after performing cyclophotocoagulation should medical tx be continued?

A

4weeks

50
Q

How can fibrosis and scarring soon after filtration devices have been placed for cases of glaucoma be prevented (2 ways)?

A

Antifibrotic agents

Beta irradiation during surgery

51
Q

What drug is used for pharmacoablation in cases of glaucoma?
How does it work?
What are the risks with this technique?
Why is this contraindicated in cats?

A

Gentamicin

Destroys the ciliary body epithelium and retina so reduces aqueous humour formation

Intractable uveitis resulting in phthisis bulbi

Risk of feline post traumatic sarcoma

52
Q

What coloured eyes does cyclophotocoagulation not work in?

Where do you avoid in this technique?

A

Blue iris

3 and 9 o’clock position as that’s where blood vessels are

53
Q

What does cyclophotocoagulation use to work?

What does it destroy?

A

Laser energy (Nd-YAG and diode lasers)

Ciliary processes

54
Q

Is glaucoma in cats normally primary or secondary?

A

Secondary

55
Q

Cats with an anteriorly luxated lens doesn’t always have an increase in IOP, why is this?

A

Cats have large anterior chambers

56
Q 
Aqueous misdirection (Aqueous flows in to the vitreous) can cause glaucoma in cats, what is the treatment for this? 
Is it uni or bilateral?
A

Vitrectomy with lens removal

Bilateral

57
Q

What is the most common cause of feline glaucoma?

A

Anterior uveitis

58
Q

Is latanaprost useful in feline glaucoma?

A

No

Will cause miosis

59
Q

What are the lines on the cornea?

What is this pathognomonic for?

A

Haabs striae

Chronic glaucoma

60
Q

Which breed does pigmentary and cystic glaucoma happen in in the USA?

A

Golden retrievers

61
Q

What dose of mannitol should be used in acute glaucoma?

A

1-2g/kg iv over 20-30mins

62
Q

When using a prostaglandin analogue in acute glaucoma how often should you use it?

A

Every 15mins 4-6 doses

63
Q

When is beta blockers useful in glaucoma?

A

Cats
Open angle glaucoma
Not in PLA in dogs

64
Q

What needs to be removed in endolaser?

A

Lens

65
Q

How can you diagnose aqueous misdirection syndrome in cats?

Treatment?

A

Shallow anterior chamber

Lendectomy

Module 8 Glaucoma & Neurophthalmology (2 decks)

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