Glaucoma

Question 1

Visual field loss

Answer 1

Retinal ganglion cell loss
Optic nerve head changes
Visual field changes

Question 2

Why is glaucoma important

Answer 2

Potentially blinding
Causes irreversible optic nerve damage
Largely manageable when caught early

Question 3

Changes in glaucoma

Cup disk ratio

Answer 3

Normal 0.3

Glaucoma 0.7

Question 4

Changes in glaucoma

Retinal nerve fiber layer

Answer 4

N- makapal

G- numinipis

Question 5

Changes in glaucoma

Visual field

Answer 5

N- manipis

G- dark part ibig sabihin nyan decreased sensitivity, hindi na nakakita yung part na yan

Question 6

Classical glaucoma visual field change

Answer 6

Superior arcuate defect

Question 7

Normal range of IOP

Answer 7

10-21mmHg

Question 8

Produces the pressure inside eyeball

Answer 8

Aqueous humor

Question 9

Aqueous humour produce via

Answer 9

Active transport in non-pigmented epithelium of the ciliary processes.

Question 10

Aqueous humour lalabas sya sa ________ and then mag de drain sa _________. Rate of ______per minute 24/7

Answer 10

Pupil
Irido-corneal angle
2 microliter

Question 11

Major pathway of aqueous humor

Answer 11

Trabecular

Question 12

Minor pathway of aqueous humor

Answer 12

Uveoscleral

Question 13

This is the major classification of family diseases of glaucoma

Answer 13

Elevated IOP

Open and closed angle

Question 14

Apoptosis

Answer 14

Programmed cell death
Cell shrinkage
Chromatin clumping

Question 15

Apoptosis kaya na mamatay yung mga

Answer 15

Retinal ganglion cells

Question 16

Role of IOP

Answer 16

Direct effect on retoganglion cell
Mechanical effect on optic nerve cell
Effect on blood flow

Question 17

Direct effect of reto ganglion cells

Answer 17

Somatic shrinkage
Dendritic changes
Heat shock response

Question 18

Mechanical effects on optic nerve head

Don’t forget that the optic nerve is the

Answer 18

Weakest point in eye

Greatest stress

Question 19

Mechanical effects on optic nerve head

Astrocyte remodeling and migration

Answer 19

Elastin deposition

Question 20

Mechanical effects on optic nerve head

Answer 20

Optic nerve is the weakest point
Astrocyte remodeling and migration
Posterior bowing and thinning of cribriform plate or lamina crib isa.

Question 21

Effects on blood flow of IOP

Formula

Answer 21

PP= MAP-IOP

Perfusion pressure
Mean arterial pressure
Intraocular pressure

Question 22

Effects on blood flow of IOP

PP dependent Axonal transport of BDNF

Answer 22

Decrease PP in glaucoma

Question 23

Mechanism of elevated IOP

Formula

Answer 23

IOP= F/C +Pe

F- aqueous flow (uL/min)
C- outflow facility (uL/mmHg)
Pe- episcleral venous pressure (mmHg)

Question 24

Mechanism of elevated IOP

Answer 24

Increased Aqueous production
Impaired aqueous outflow
Elevated episcleral venous pressure

Question 25

More common mechanism of elevated IOP

Answer 25

Impaired aqueous outflow

Question 26

Primary open angle glaucoma Decreased number of pores in TM Decreased Cellularity of TM (trabecular meshwork)

Answer 26

Senescent

Question 27

Primary open angle glaucoma 88% in POAG Treatment associated with + response

Answer 27

Helicobacter pylori

Question 28

Primary open angle glaucoma Vasoregulation Apoptosis

Answer 28

Optineurin

Question 29

As we age the ______ which is the filtering portion of your angle has decreased that leads to slow of aqueous humor tumataas yung eye pressure

Answer 29

Trabecular meshwork

Question 30

Secondary open angle glaucoma

Answer 30

May antecedent cause

Question 31

Secondary open angle glaucoma Steroid induced glaucoma

Answer 31

Myocillin/Tigr protein expression Increased aqueous viscosity Triggered by Myoc/ Tigr gene

Question 32

Secondary open angle glaucoma Basement membrane disease Exfoliated material obstruct TM

Answer 32

Pseudoexfoliate glaucoma

Question 33

Secondary open angle glaucoma Pigmentary glaucoma Reverse

Answer 33

Pupillary block

Question 34

Secondary open angle glaucoma Pigmentary glaucoma Posterior bowing of

Answer 34

Iris (concave)

Question 35

Secondary open angle glaucoma Pigmentary glaucoma Pigments

Answer 35

Epithelium contact with lens Released causing Krukenburg spindles Phagocytosed by TM causing decreased TM function

Question 36

Secondary open angle glaucoma Increased episcleral resistance Uncommon non familial disease recognizable at birth by a characteristic nevus flammeus on one side of the face.

Answer 36

Sturge-Weber syndrome

Question 37

Secondary open angle glaucoma Increased episcleral resistance Trauma

Answer 37

AV fistula

Question 38

Secondary open angle glaucoma Increased episcleral resistance May cause angle neovascularazation due to widespread ocular ischemia

Answer 38

Carotid cavernous fistula

Question 39

Medical treatment cannot reduced the intraocular pressure below. Surgery is associated with high risk complication.

Answer 39

Increased episcleral resistance

Question 40

Angle closure glaucoma

Answer 40

Surgical | Sumasakit talaga, unlike sa open na incidental lang

Question 41

Angle closure glaucoma Acute symptomatic

Answer 41

``` Pain Redness Blurred vision Haloes Nausea/vomiting ```

Question 42

Angle closure glaucoma Maybe asymptomatic MC wrong mngt

Answer 42

Chronic

Question 43

Resistance of Irido-lenticular interface Pressure bows iris anteriorly Dilation causes angle to close May be lens/ cataract induced

Answer 43

Pupillary block glaucoma

Question 44

Iris is convex

Answer 44

Pupillary block glaucoma

Question 45

Central iris flat centrally and convex peripherally | Angle closes on dilation

Answer 45

Plateau iris

Question 46

Akala mo open sya, flat yung central iris pero sa likod pala convex. On dilation, the angle closes the iris

Answer 46

Plateau iris

Question 47

There is anterior ciliary rotation. Yung ciliary body mo is anteriorly rotated so yung flow ng aqueous mo baliktad.

Answer 47

Supraciliary effusions

Question 48

``` Uveitis Malignant glaucoma (pero hindi cancer) ```

Answer 48

Supra ciliary effusions

Question 49

Super ciliary effusions Drug effect

Answer 49

Sulfa | Topiramate

Question 50

Misdirection of aqueous flow

Answer 50

Malignant glaucoma

Question 51

Aka ciliary block glaucoma

Answer 51

Malignant glaucoma

Question 52

Following surgery upon open eye with marked increased IOP and a closed or narrow angle Post operativel, the IOP is higher than expected and the lens is pushed forward as a result of the collection of aqueous in and behind the vitreous body.

Answer 52

Malignant glaucoma

Question 53

Blurred distance vision but improved hear vision. This is followed by pain and inflammation

Answer 53

Malignant glaucoma

Question 54

Role of ocular blood flow and oxygenation Triggers glutamate cascade May impair Axonal transport

Answer 54

Ischemia

Question 55

Role of ocular blood flow and oxygenation Impaired compensation on

Answer 55

Open angle glaucoma

Question 56

Role of ocular blood flow and oxygenation Dysautoregualtion in

Answer 56

Normal tension glaucoma

Question 57

Role of ocular blood flow and oxygenation Others

Answer 57

Nocturnal hypotension and NTG Sleep apnea and NTG Migraine and NTG

Question 58

Aka low tension glaucoma | Normal yung pressure

Answer 58

Normal tension glaucoma

Question 59

Purely vascular disease | Chr 10

Answer 59

Normal tension glaucoma

Question 60

Conclusion

Answer 60

Glaucoma is a multi- faceted and multi factorial disease Can occur at any intraocular pressure Misdiagnosis can be visually devastating A high index of suspicion is necessary

Question 61

A family diseases having a common characteristic progressive optic neuropathy and associated visual field loss.

Answer 61

Glaucoma