Glaucoma Flashcards
Open + Closed (52 cards)
What is the only modifiable risk factor for glaucoma?
Raised intraocular pressure (IOP)
Name three risk factors for glaucoma
Increasing age
Myopia
Afro-Caribbean ethnicity
What causes the optic nerve damage in glaucoma?
Increased intraocular pressure leading to damage at the optic disc and nerve
What is the key difference in drainage between open and closed-angle glaucoma?
(1) Open-angle glaucoma:
Drainage is slow because the trabecular meshwork is clogged.
(2) Closed-angle glaucoma:
The iris gets pushed forward, blocking the drainage angle
What is rubeotic glaucoma and when does it occur?
Glaucoma due to neovascularisation (new vessels obstruct the angle)
= seen in late diabetic eye disease
What is the clinical presentation of acute closed-angle glaucoma?
- Sudden onset red eye 1/3 present as an emergency
- Visual loss
- Headache
- Nausea and vomiting
- Dilated pupil
- Cloudy cornea
Signs
1. Red eye, cloudy cornea,dilated pupil
2. Can lose sight very quickly
3. Hyperopia (farsightedness)
Which ethnic group and refractive error increase the risk of closed-angle glaucoma?
Asian ethnicity and hyperopia (farsightedness)
How does open-angle glaucoma typically present?
Usually asymptomatic and detected during routine screening; signs include peripheral vision loss and a cupped optic disc
What is the significance of a cupped optic disc?
Indicates loss of retinal ganglion cells and nerve tissue
What does a pale optic disc suggest in the context of glaucoma?
Optic atrophy due to advanced disease
Is high intraocular pressure alone diagnostic of glaucoma?
High pressure in the eye but no damage = not glaucoma.
That’s called ocular hypertension.
Glaucoma = high pressure and damageNo – it’s called ocular hypertension without visual field or optic nerve changes
What is the 1st line treatment for primary open-angle glaucoma?
Prostaglandin analogues e.g. latanoprost
What is the 2nd treatment for primary open-angle glaucoma?
β blockers, carbonic anhydrase inhibitors e.g. acetazolamide
How is acute closed-angle glaucoma managed?
- Emergency reduction of IOP with pilocarpine 4% eye drops ± oral meds;
- The definitive treatment is laser peripheral iridotomy
Name three systemic conditions or drug classes that are risk factors for primary open-angled glaucoma
Hypertension, diabetes mellitus, and corticosteroid use
Describe the typical progression of visual field loss in Primary Open-Angle Glaucoma
Starts as nasal scotomas and progresses to ‘tunnel vision’
What additional optic disc features may be seen in POAG besides cupping and pallor?
Cup notching (especially inferiorly) and disc haemorrhages
What investigation assesses the configuration of the peripheral anterior chamber? Explain why
Gonioscopy
= Explanation:
The peripheral anterior chamber is the front part of the eye near the iris and cornea where the drainage angle is located.
Gonioscopy lets doctors look at this angle to see if it’s open or closed.
In open-angle glaucoma, the drainage angle is open but clogged inside.
In angle-closure glaucoma, the angle is physically closed or blocked.
So gonioscopy is the key test to tell if the glaucoma is open-angle or angle-closure by assessing that angle’s configuration
A 74-year-old male presents to his ophthalmologist for review - his sister has been diagnosed with primary open-angle glaucoma and he is concerned that this may also be the cause of his worsening eyesight. He has a past medical history of hypertension, diabetes mellitus, and prostate cancer.
What potential finding would support a diagnosis of this condition?
Myopia
A 71-year-old man is under the ophthalmology clinic for bilateral primary open-angle glaucoma.
He has been using latanoprost eye drops but despite this, his intraocular pressures remain elevated.
The ophthalmologist has to add in a second topical agent to try to reduce intraocular pressure further by decreasing the rate of aqueous humour production.
Which class of drug should be offered next?
Beta blocker
“ocular pain, decreased visual acuity, worse with mydriasis, haloes around lights” This suggests what?
Acute angle closure glaucoma
A 62-year-old woman presents to the clinic for a routine eye examination. She reports occasional blurriness in her vision and has noticed increasing difficulty with her peripheral vision. On examination, her intraocular pressure (IOP) is measured at 26 mmHg in both eyes. Her visual field test reveals peripheral loss. She has a background of well-controlled hypertension. She has no other significant medical issues, and her family history is notable for glaucoma in her mother.
What is the most appropriate next step?
360° selective laser trabeculoplasty (SLT) is first-line if the IOP is ≥ 24 mmHg
A patient is undergoing medical management for primary open-angle glaucoma. The class of medication prescribed acts to reduce intraocular pressure. After a few weeks of treatment, the patient reports increased eyelash length, and iris and periocular pigmentation.
What class of medication has caused these side effects?
Prostaglandin analogues
A 62-year-old woman presents to her GP with a painful right eye associated with blurred vision, nausea and vomiting.
On examination, the patient’s right eye is red with a fixed dilated pupil. When her left eye is covered she is unable to read a poster on the wall, even with her glasses on. Her left eye appears normal.
The GP refers the patient for immediate ophthalmology assessment.
What is the definitive treatment for the most likely diagnosis?
Laser peripheral iridotomy is the definitive treatment for acute angle-closure glaucoma
