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Opthalmology Sure Success > Glaucoma > Flashcards

Glaucoma Flashcards

1
Q

Structures in angle of AC seen by gonios opy.

A

Outward to inward:
Schwalbe ‘s line
Trabecular meshwork
Scleral ring
Ciliary body band

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2
Q

Portions of trabecular mesh work

A

Uveal portion
Corneoscleral
Juxtacanalicular mesh work -
Major proportion of normal resistance to aqueous outflow.

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3
Q

Why is gonioscope used for seeing angle of anterior chamber ?

A

Critical angle of corneal air interface is 46 degrees.
Lead to total internal reflection.

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4
Q

Openness of angle is measured by ….. at ….degrees

A

Van herick’s method.
60 degree.

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5
Q

Types of gonioscopy

A

Direct : koeppe
Indirect:
Zeiss
Goldmann
Sussman
Possner

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6
Q

Other uses of gonioscopy other than seeing the angle of anterior chamber. (4)

A
  1. To visualize any intraocular foreign body in the angles.
  2. Diagnose angle recession
  3. Evidence of neovascularization at the angle: PDR, CRVO
  4. In CRAO: do goniomassage.
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7
Q

Acqeous humor is secreted by ……. by ……

A

Non pigmented ciliary epithelium
By active secretion. (90%)

Passive: ultrafiltration and diffusion

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8
Q

Uveoscleral outflow is
Increased by ……
Decreased by ……

A

Prostaglandin analogues
Miotics

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9
Q

Acqueous humor is ………(acidic/alkaline)
Ig present in aqueous humor

Increased acqueous humor LDH is seen in …..

A

Alkaline

IgG

Retinoblastoma

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10
Q

In comparison to plasma, aqueous humor has …….levels (4)

A

Ascorbate 20times higher
Low glucose
Low protein
Hyperosmotic

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11
Q

When compared to blood, …….has higher concentration of ascorbate

IOP normal range …..
Peaks in …..

A

Vitreous humor

11-21mmhg
Early morning

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12
Q

Most accurate method for IOP

Variable force fixed area tonometers eg (3)

A

Mannometry

Goldmann
Perkins
Non-contact tonometer

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13
Q

Non contact tononeters (3)

A
  1. Air puff tonometer
  2. Ocular response analyzer
  3. Corvis
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14
Q

Pachymetry measures ……

Outflow of acqueous humor measured by …..

A

Corneal thickness

Tonography
(Tonometry measures IOP)

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15
Q

Diaton tonometer is …….

Rebound tonometer is …..

Tonometer useful in post LASIK

A

Transpalpebral tonometer- can measure over the eyelid

Self tonometer

Dynamic contour tonometer : DCT/pascal

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16
Q

Optic nerve derived from ……

Trabecular mesh work is pressure…..
Uveoscleral outflow is pressure …..

A

Optic stalk

Dependent
Independent

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17
Q

Rapid change of glasses in:
Elderly
Young adult

A
  1. Glaucoma
  2. Keratoconus
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18
Q

Advantages of diaton Tonometer (3)

A
  1. Keratoplasty - corneal transplant
  2. Corneal ulcer
  3. Tarsorraphy
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19
Q

Dark room procedures (3)

A
  1. Slit lamp
  2. Gonioscopy
  3. Direct and indirect opthalmoscopy
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20
Q

What is pentacam? (2)

A

Used for keratoconus
Preop evaluation of LASIK- to see the cornea.

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21
Q

Define posner schlossman syndrome

A

Corneal epithelial edema-increased IOP.
Another name for angle closure glaucoma
Also called : glaucomatocyclitic crisis

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22
Q

Causes of colored halos (7)

A
  1. Angle closure glaucoma-posner syndrome
  2. Corneal edema
  3. Acute mucopurulent conjunctivitis
  4. Senile immature cataract
  5. Acute anterior uveitis
  6. Epiphora
  7. Dirty contact lens usage
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23
Q

Congenital glaucoma develops from …..
3 types of congenital glaucoma

A

Developmental anomaly of angle of anterior chamber.
True congenital glaucoma:
IOP rise in intrauterine life

Infantile glaucoma: birth-3 years
Juvenile glaucoma: 3-16 years

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24
Q

Congenital glaucoma mc seen in …..
On chromosome…..
Most cases are …

A

Boys, b/l
Chromosome 2- AR

Sporadic

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25
Q

Pathology of congenital glaucoma (2)

A

Trabeculodysgenesis
Barkan’s membrane covering the angle of eye.

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26
Q

Normal corneal diameter is ……at ….months of age and …… at 1 year.

A

10mm, at 6 months of age.

12mm at 1 year

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27
Q

Differentiate between posner and fuch’s heterocyclitis

A

Posner: acute congestive angle closure glaucoma

Fuch’s : angle closure glaucoma + iris hypochromia + grey white nodules on anterior iris

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28
Q

Symptoms of congenital glaucoma (7)

A
  1. Lacrimation
  2. Photophobia
  3. Blepharospasm
  4. Hazy and large cornea
  5. Corneal diameter >12mm
  6. Buphalmos
  7. Haab’s striae
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29
Q

Define haab’s striae
Progressive myopia of congenital glaucoma is due to ….(4)

A

Horizontal breaks in descements membrane.

  1. Globe enlargement
  2. Subluxated lens
  3. Axial myopia
  4. Optic disc cupping
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30
Q

Signs of congenital glaucoma (4)

A
  1. IOP >21mmhg
  2. Optic nerve cup:disc ratio=>0.3
  3. Horizontal corneal diameter >12.5
  4. Open angle with high iris insertion on gonioscopy.
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31
Q

IOP can be minimally reduced by: (3)

A
  1. General anesthetics: halothane
  2. Corneal edema
  3. Overventilation
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32
Q

IOP may be falsely increased with …..(6)

A
  1. Ketamine
  2. Succinylcholine
  3. Endotracheal intubation
  4. Pressure from anethetic
  5. Speculum use
  6. Inadequate ventilation
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33
Q

2 genes causing primary open angle glaucoma

A
  1. Myocilin- MYOC- on chrom 1q
    aka- TIGR( trabecular meshwork induced glucocorticoid response protein.
  2. Optineurin: chromosome 10p
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34
Q

Family history of POAG

Corticosteroid response of POAG

A

Sibling have greater chance than offspring

Significant increase in IOP.

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35
Q

IOP changes in POAG

A
  1. Diurnal variation
  2. IOP >5mmHg- suspicious of glaucoma
    IOP> 8mmHg- dx of glaucoma
    —-although the whole reading is still <21mmhg.
  3. In late stage: IOP: >21mmhg
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36
Q

Splinter hemmorhage near disc margin aka….
Mc in……

A

Drance hge
Mc in normal tension glaucoma

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37
Q

RNFL defect seen in POAG is with ….
Advanced stages of POAG

A

Red free light-green filter

Bean pot cupping- total cupping with loss of bending of retinal vessels at margin of disc.

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38
Q

What is laminar sign?

A

Opening of lamina cribrosa visible upto margin of disc.

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39
Q

Earliest visual field defect in POAG
Earliest clinically significant field defect is..

A

Isopteric contraction

Isolated paracentral scotoma

40
Q

Arcuate Scotsman is also called …..
What is nasal step?

A

Bjerrum scotoma
When 2 acruate scotoma meet each other at the horizontal meridian at sharp right angles to each other.

41
Q

Double arcuate scotoma leads to ….

Last visual field to be lost in POAG

A

Tubular vision

Temporal island of visual field- with no perception of light.

42
Q

Stimulus size of…..is used in Humphrey visual field

RNFL is analyzed by ….(3)

A

3 MC (4mm2)

OCT
VCC
HRT

43
Q

RNFL analysis is done to detect …..

Central/centrocecal scotoma is dx of …..(2)

A

Preperimetric glaucoma

ONH
Macular d/o

44
Q

Water drinking provocative test is used for ….
Other tests are…(4)

A

POAG

  1. Jugular vein compression
  2. Bulbar pressure test
  3. Priscol test
  4. Caffeine test
45
Q

DDLS is ……

Laser trabeculoplasty is useful in ….(3)

A

Disc Damage Likelihood scale
POAG
Pseudoexfoliation glaucoma
Pigmentary glaucoma

46
Q

Laser trabeculoplasty not useful in…..(2)

A

Angle closure glaucoma
Uveitic glaucoma

47
Q

2 types of trabeculoplasty adv /disadv of them

A

Argon laser: cause scarring of TM
not repeatable

Selective laser trabeculoplasty:
Uses 532mn freq doubled Nd YAG
No scarring of TM, Repeatable

48
Q

Antimetabolites are used in trabeculectomy to minimize scarring but they form blebs.

What are the indications of anti metabolite? (5)

A
  1. Younger patients
  2. African Black race
  3. Neovascular/ I.F glaucoma
  4. Combined surgery
  5. Previously failed trabeculectomy
49
Q

Artificial implants eg (3)

A

Molteno
Baerveldt
Ahmed glaucoma valve

50
Q

Egs of MIGS (3)

A

Express shunt
Canaloplasty
Trabectome

51
Q

Cause of normal tension glaucoma

A

Chronic low vascular perfusion-hypotension, CVS disease that makes the optic nerve head susceptible to damage by normal IOP.

52
Q

NTG mc in …..
Visual field defects are…..
Optic nerve head is ….

A

Japan
Denser and closer to fixation

Larger

53
Q

Association more commonly seen in NTG than POAG (6)

A
  1. Raymaud’s phenomenon
  2. Nocturnal systemic hypotension
  3. Over rx for systemic HTN
  4. Reduced blood flow to opthalmic artery.
  5. Paraproteinemia
  6. Presence of serum autoantibodies
54
Q

Beta blocker used for asthma patients
Metipranolol causes …

A

Betaxolol- cardioselective

Granulomatous uveitis

55
Q

S/e of miotics

A

MY EYE
Head and brow pain
Retinal detachment
Nasolacrimal obstruction
Myopia
Iris cyst
Lens cataract

56
Q

S/e of beta blocker (3)

A

BDS
Blepharoconjunctivitis
Dry eye
Superior punctuate keratitis

57
Q

S/e of PG analogue

A

E FGHI
E-cystoid macular edema
PDF2
Hypertrichiasis
Iris pigment.

58
Q

What is dipevefrine?

A

Analogue of epinephrine
Alpha 2 agonist
S/e: black pigmentation of conjunctiva

59
Q

Appearance of cystitis macular edema

Smoke stack appearance

A

Flower petal

Central serous retinopathy

60
Q

S/e of apraclonidine (2)

A

Lid retraction
Follicular conjunctivitis

61
Q

C/I of carbonic anhydride inhibitors

A

C/I sulfa allergy
Keratoplasty/ corneal d/o

62
Q

Eg of rho kinase inhibitor

A

Ripasudil
Netarsudil

63
Q

MOA of Rho kinase inhibitor
S/e

A

Increases aqueous outflow through direct action of trabecular mesh work and schlemm canal.

Conjunctival hge
Conjunctival hyperemia

64
Q

Ripasudil s/e (2)

A

Corneal endothelial dysfunction
in fusch’s endothelial dystrophy
Post cataract surgery corneal damage

65
Q

DOC for glaucoma in pregnancy

A

Brimonidine

66
Q

Hyperosmotic used in diabetics (2(

A

Mannitol
Isosorbide

67
Q

MOA of PACG
Features of latent glaucoma (prodomal phase)

A

Pupillary block mechanism

  1. Transient IOP- 40-60mmhg
  2. Colored haloes
68
Q

Intermittent glaucoma stage of PACG

Haloes seen in PACG is ….

A

Predisposed eye with occluded angle. -mysriasis in dark room

Blue-violet innermost

69
Q

Define Vogt’s triad

A
  1. Glaucomafleckon- anterior subcapsular lens opacity.
  2. Iris atrophy
  3. Slightly Dilated non reactive pupil- sphincter atrophy.
70
Q

Double hump sign and sine wave sign on gonaioscopy seen with ….

A

Plateau iris

71
Q

What is phacolytic glaucoma ?

A

Seeen in hyper mature cataract
Leakage of lens protein through microscopic defects in intact capsule

Macrophages block the TM and occlude blood flow.

72
Q

Deep anterior chamber seen in ….
Rx for phacolytic glaucoma

A

Phacolytic glaucoma -open angles

Decrease IOP
Cataract extraction
Thorough AC wash

73
Q

What is lens particle glaucoma ?
Rx (3)

A

Disruption of lens capsule during cataract extraction or penetrating injury—free particulate lens material released and obstruct TM

Rx:
1. Lower IOP
2. irrigation aspiration of lens matter in AC
3. Vitrectomy- if associated with posterior capsule rupture

74
Q

What is phacomorphic glaucoma? (5).
Rx.

A

Ass with intumescant cataract
High IOP
Shallow AC
Corneal edema
Pain

Extraction of cataract after lowering IOP

75
Q

Phacoanaphylactic glaucoma seen in….

A

Autoimmune granulomatous reaction to lens protein- from previous cataract sx or penetrating injury.

76
Q

What is phacotropic glaucoma?

A

Dislocation of lens into AC-blocking angle and giving rise to secondary angle closure glaucoma.

77
Q

Define neovascular glaucoma

CRVO is aka…..

A

Neovascularisation of iris and angle of AC-rubeosis iridis.

90 day glaucoma

78
Q

Causes of neovascular glaucoma (7)

A
  1. DR
  2. Ischemic CRVO
  3. Sickle cell retinopathy
  4. ROP
  5. Long standing intraocular tumor
  6. CRAO
  7. Carotid obstructive disease
79
Q

Rx for neovascular glaucoma

A

Panretinal photocoagulation + intravitreal avastin ( bevacizumab)
IOP uncontrolled:
Trabeculectomy + antimetabolites/
Artificial valve.

80
Q

…….glaucoma came seen following traveculectomy/ any intra operative sx.
Features (3)

A

Ciliary block- malignant glaucoma.

  1. Flat AC
  2. Negative Seidel test-no wound leak
  3. Markedly raised IOP
81
Q

Mechanism of ciliary block glaucoma

A

Ciliolenticular block/ ciliovitreal block—acqueous misdirection syndrome

82
Q

Only glaucoma Rx with atropine is ….
Sx done is ….

A

Ciliary block-malignant glaucoma
Mydriatics: phenylephrine + atropine1%

Posterior sclerotomy

83
Q

Posner syndrome is aka

Seen with ……
Associated with …..

A

Glaucomatocyclitic crisis

U/L disease of young adults

HLABW54

84
Q

Sms of posner syndrome

A
  1. Recurrent attacks of acute secondary ACG
  2. Mild anterior uveitis -HTN uveitis
  3. Raised IOP- due to acute trabeculitis
85
Q

Signs of posner syndrome (4)

A
  1. White eye- minimally congested
  2. Corneal epithelial edema- colored haloes
  3. Fine white central keratin ppt
  4. IOP is very high
86
Q

3 ICE syndromes

A

Iridocorneal endothelial syndrome
1. Progressive iris atrophy—>
Corectopia- distortion of pupil
Polycoria- multiple pupils

  1. Chandler syndrome—> corneal edema
  2. Cogan reese syndrome—>
    Nodular/diffuse pigmented lesion
87
Q

ICE syndrome affects …..
Mx feature of ICE syndrome

A

One eye of young to middle aged women

Hammered silver appearance-corneal cells that proliferate to form endothelial membrane.

88
Q

Rx of ICE syndrome

A

Trabeculectomy + antimetabolites /
Glaucoma valve

89
Q

Final stage of any glaucoma is …..
C/f

Complications of the above (3)

A

Absolute glaucoma

Painful, irritable, extremely high stony hard eye

Corneal ulceration
Staphyloma formation
Atrophic bulbi

90
Q

Rx for absolute glaucoma (3)

A

Cyclocryotherapy
Transacleral diode laser photocoagulation
Endoscopic cyclophotocoagulatiom

91
Q

What is pseudoexfoliation glaucoma ?
Pigment along scalbe’s line is called ….

Complication

A

Whitish powdery material at pupillary margin and on lens surface(3 ring sign)

Sampaolesi line

Zonular dehiscence
Vitreous loss during cataract surgery

92
Q

Glaucoma that may be seen with young myopic males
Rx.

A

Pigment glaucoma- pigment on corneal endothelium. -krukenberg spindle.
Hyperpigmented open angle.

YAG laser PI to reverse pupillary block

93
Q

Angle recession glaucoma is seen after …..
Gonisoscopy featires

A

Blunt trauma to eye
Irregular widening of ciliary body band on gonioscopy

94
Q

Very high IOP with colored haloes s/o

What is UGH syndrome? Ass with ….

A

Epidemic dropsy—> hypersecretion glaucoma

Uveitis
Glaucoma
Hyphema

Anterior chamber lens implantation

95
Q

Ghost glaucoma occurs with …..
How this happens?

A

Aphakic eyes with vitreous hge
After 2 weeks of vitrous hge, RBC lose their pliability and become khaki colored-ghost cells-pass from vitreous cavity —-> AC and block trabeculae leading to rise in IOP.

96
Q

What are ghost glaucoma?

A

Aphakic eyes with vitreous hge.
After 2 weeks of hge, RBC lose their pliability and become khaki colored. Then pass from vitreous to AC and block trabecular meshwork -> increase in IOP.

97
Q

Glaucoma due to increased episcleral venous pressure seen in ….

A

Sturge weber syndrome -carotico cavernous fistula

Opthalmology Sure Success (3 decks)

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