Glaucoma

Question 1

is a group of eye conditions characterized by progressive damage of the optic nerve

Answer 1

Glaucoma

Question 2

Second leading cause of blindness worldwide

Answer 2

Glaucoma

Question 3

What causes glaucoma?

Answer 3

Mainly caused by persistent elevation of intraocular pressure (IOP)

Question 4

What’s the normal IOP?

Answer 4

10-21 mmHg

Question 5

What’s the diagnostic test for Glaucoma?

Answer 5

Tonometry

Question 6

It is a diagnostic test that provides IOP by measuring the pressure needed to flatten the cornea

Answer 6

Tonometry

Question 7

Precautions during tonometry

Answer 7

-Anesthetic eyedrops are instilled prior to procedure
- Patient should not hold breath during procedure as this may overestimate IOP

Question 8

What are the Risk Factors of Glaucoma?

Answer 8

-African American Race
- Cardiovascular Disease
- Diabetes
- Family History of Glaucoma
- Migraine syndromes
- Nearsightedness (myopia)
- Older Age
- Previous eye trauma
- Prolonged use of topical or systemic corticosteroids
- Thin cornea

Question 9

-Nutrient-filled fluid produces in the posterior chamber and drains in the anterior chamber
- Its volume directly influences the IOP

Answer 9

Aqueous Humor

Question 10

-Mainly Water
- Maintains the shape of the eye

Answer 10

Vitreous Humor

Question 11

Factors affecting AH drainage

Answer 11

-Angle created by the iris and cornea
- Integrity of the drainage system

Question 12

The process of the normal pathway from production to drainage of aqueous humor

Answer 12

-Ciliary body produces AH
- AH passes through the pupil into the anterior chamber
- AH drains through the trabecular meshwork into Canal of Schlemm

Question 13

What maintains a normal IOP?

Answer 13

An equal input to output volume of Aqueous Humor maintains a normal IOP.

Question 14

Anterior Chamber Angle of Primary Open-Angle Glaucoma (POAG)

Answer 14

Open

Question 15

Drainage System of Primary Open-Angle Glaucoma (POAG)

Answer 15

Obstructed

Question 16

Onset of Primary Open-Angle Glaucoma (POAG)

Answer 16

Slow- onset beginning with one eye then may progress to the other if left untreated

Question 17

Clinical Manifestations of Primary Open- Angle Glaucoma (POAG)

Answer 17

-Persistent dull eye pain in AM
- Tunnel Vision (Loss of peripheral vision)

Question 18

Anterior Chamber Angle of Primary Closed-Angle Glaucoma (PCAG)

Answer 18

Closed/Narrowed

Question 19

Drainage System of Primary Closed-Angle Glaucoma (PCAG)

Answer 19

Intact

Question 20

Onset of Primary Closed- Angle Glaucoma (PCAG)

Answer 20

Rapid-Onset

Question 21

Clinical Manifestations of Primary Closed-Angle Glaucoma

Answer 21

-Severe, rapid-onset eye pain
- Halos around lights (Presence of bright circles around light source)
- Blurred Vision
- Nausea/Vomiting

Question 22

Medical Management of Primary Open-Angle Glaucoma (POAG)

Answer 22

Topical Medications (Eye Drops) – lowers IOP by increasing outflow of AH or decreasing production of AH

Question 23

Timolol Drug

Answer 23

-First line drug of (POAG)
-Beta Blocker
- Action: Decrease AH production
- Side Effects: Hypotension, Bradycardia, Fatigue

Question 24

Acetazolamide

Answer 24

-Carbonic Anhydrase Inhibitor
- Action: Decrease AH production
- Side Effects: Stinging/burning sensation in eyes

Question 25

Pilocarpine

Answer 25

-Third Line - Cholinergic Agent (Miotics) Action: Increases draining of intraocular fluid through trabecular meshwork -Side Effects: Difficulty seeing at night or in the dark pupil constriction

Question 26

What are the drugs for Primary Open-Angle Glaucoma (POAG)

Answer 26

-Timolol - Acetazolamide - Pilocarpine

Question 27

What's the Emergency Medical Management of Primary Closed-Angle Glaucoma?

Answer 27

-Supine Position - Acetazolamide IV/PO then Timolol eye drops - Analgesics for pain and topical steroids to reduce inflammation - Anti-emetics if with nausea/vomiting

Question 28

Rationale of Supine Position in Emergency Medical Management

Answer 28

-improves lens position thereby removing pupil block

Question 29

Rational to Administer Acetazolamide IV/PO then timolol eye drops

Answer 29

To lower IOP

Question 30

After 1 hour of implementing emergency medical management

Answer 30

-Pilocarpine 2% or 4% - 2 doses spaced 15 minutes apart -Mannitol IV or Glycerol IV if IOP is still elevated after 2nd dose of pilocarpine

Question 31

Surgical Management of Primary Open-Angle Glaucoma

Answer 31

Laser Trabeculoplasty

Question 32

Uses laser beam directed at the trabecular meshwork to alter its pores resulting to an increase in AH outflow

Answer 32

Laser Trabeculoplasty

Question 33

Surgical Management of Primary Closed-Angle Glaucoma (PCAG)

Answer 33

-Laser Iridotomy -Treatment of choice -Surgical Iridectomy -Alternative to laser iridotomy when cornea is extremely cloudy, or iris is too thick

Question 34

Creation of an opening in the iris using a laser beam. The opening serves as passageway for the trapped AH in the posterior chamber

Answer 34

Laser Iridotomy

Question 35

What to avoid in Glaucoma?

Answer 35

Atropine Sulfate Bendryl Cogentin

Question 36

Rationale of Avoiding ABCs in Glaucoma

Answer 36

Promotes pupillary dilatation bringing the iris closer to the angle of outflow of aqueous humor