glaucoma Flashcards
(26 cards)
Open angle Glaucoma
symptoms- px has paracentral VFD esp when reading
Signs:-
- characteristic optic disc defects
- Vf loss
- +/- IOP
Open anterior chanber angle
Acute angle closure
symptoms:-
- Severe headaches
- nausea and vomiting
- blurred vision
- haloes around light
signs:-
- red eye
- fixed mid dilated pupil
- shallow anterior chamber
- very high IOP
- cloudy cornea
Primary angle closure
symptoms:-
- browache
- haloes around light
Signs:-
- narrow angle
-iridiotrabecular contact on gonioscopy
- +/- posterior anterior synachae
- +/- IOP
Primary open angle pathogenesis
IOP traised during to trabecular meshwoerk, angle open and aqueous flows freely
Not as freely able to pass theough trabecular mehswork and schlems canal, due to changes within meshwork
Primary angle closure glaucoma pathogenesis
raised IOP, due to narrowing of angle
trabecullar meshwork can also become disfunctional
Increased prevalence with age, iris diaphram moves anteriorly cauising progressive narrowing of angle over time.
Pigement dispersion syndrome
atypical iris configuration therefore lens zonules makin contact with posterior iris
in area where pigment is shead, translumination becomes apparent
pigment can block trabecular meshwork and cause glaucoma overtime, tratment same as open angle
Pseudoexfoliation syndrome
white flakey protein material on anterior surface of lens
flqakes of material can circulate into anterior chamber and can physically bock trabecular meshwork and increase IOP therefore, glaucomatous damage
causes weakend lens zonules and therefore increases risk of complications.
Steroid induced glaucoma
px who are steroid responders can develop due to increased IOP due to corticosteroids
px will be characterised as high, moderate or low responders
Thyroid related glaucoma
Swelling of ealls exerting force on globe
raised episcleral venous pressure dur to swelling og tissue within orbit
IOP can become elevated in gaze compared to primary position during to inferior rectus muscle intendentifiying globe
Phacolytic glaucoma
Occurs in hypermature cataracts
leaking of lens proteins which obstruct anterior angle chamber
treated with lens removal as cataract suregery more technically challanging
Ghost cell glaucoma
Occurs following vitreous haemorrhage
3-4 weeks post
ghost cells block trabecullar meshwork therefore obstructing aqueous outflow
does not typically occur after an anterior segment bleed during to relatially rapid circularion of aqueous
Uveitic Glaucoma
IOP raised following anterior uveitis
Obstucts trabecullar meshworm by inflammatory materials
chronic cases can casuse peripheral anterior synachae, blocking the angle
Angle recession
Following blunt trauma
angle wide but non fucntional dur to damage or trauma therefore increased output
- angle may appear deeper too
IOP elevation occurs many years after inital trauma
Iridiocorneal endo syndrome
disorder affecting corneal endothelium
common in woman 20-50 typically affecting 1 eye
atrophy of iris also seen as correctorpia of the pupil
beaten metal appearance of corneal endothelium
Optic disc structural / functional changes
Physical changes to ONH or RNFL
changes to visual function usually VF but can also be central VA in advanced cases
Glaucomatous Optic Disc
Increased cup to disc
focal thinning of NRR
notchng or narrowing of NRr
NFL defects
APON ( sup or inf / periperipheral atrophy / laminate dots, visible lamination cribresa)
When assessing disc consider
symmerty
general changes in appearnace
difinitive glaucomatous changes
overtime changes= shift of BV pos, thinning of NRR, increasing pallor, increase in CD ratio
further changes to consider
changes on BV pos
haemorrhage of disc rim
changes in peripapillary atrophy
changes in CD ratio
focal pallor
notching or thinning of NRR
comparison with baseline
For sus disc record
CD
PPA
haemorrhages
volk lens used
disc drawing
size of disc
DDLs score
Bjerrums area defect
typically superior but can also be inferior
10-20 deg from fixation
most common early glaucomatous defects
Arcuate defect
coalesnce of the smaller isolated defect supeior or inferior
typically 10-20 deg from fixation
paracentral defects
within 10 deg of fixation
often small but can be deep
respect horozontal midline
px symptomatic of VF loss - often noticed with reading
more common in tenson but occurs in all types
Nasal step
superior or inferior nasal defect
Respects horozontal midline
temporal wedge
less common
coressponding to loss of nasal NRR
extends outwards from blindspot
