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NERVOUS SYSTEM > L5 - GLAUCOMA + CATARACT > Flashcards

L5 - GLAUCOMA + CATARACT Flashcards

1
Q

Cornea does __ of focusing of the eye

Lens does __ of focusing of the eye as well as ___

(emphasized)

A

Cornea does 2/3 of focusing of the eye

Lens does 1/3 of focusing of the eye as well as fine tuning

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2
Q

What is the 2nd leading cause of bilateral blindness in the world?

(emphasized)

A

Glaucoma

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3
Q

Glaucoma definition

A

A progressive optic neuropathy - p/w acquired optic nerve atrophy accompanied by loss of retinal ganglion cells + their axons

(ganglion cell damage = death of ganglion cell axons = optic nerve damage)

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4
Q

What happens to the optic cup as glaucoma progresses?

emphasized

A

As more nerves (axons) die the optic cup gets larger

Cup to disc ratio used to describe severity of glaucoma
*cup:disc = 1 = all nerves dead

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5
Q

1 risk factor for glaucoma

emphasized

A

Elevated IOP

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6
Q

What is the most important factor for preserving vision in glaucoma?

A

Early DX*/TX

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7
Q

Aqueous humor is made in the ___ and drains from ___ + ___

What happens when this drain is clogged?

A

Aqueous humor is made in the ciliary body and drains from trabecular meshwork + episcleral veins

What happens when this drain is clogged? = IOP increases

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8
Q

What is the MC form of glaucoma?

Is it chronic or acute?

Is damage reversible? (emphasized ^)

A

Primary Open Angle Glaucoma (POAG)

Chronic

Damage is irreversible (emphasized ^)

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9
Q

What is a hallmark feature of Normal Tension Glaucoma?

A

Normal IOP

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10
Q

A patient p/w sudden rise in IOP which causes pain, redness, N/V, and decreased vision

What form of glaucoma would you suspect?

A

Primary Angle Closure Glaucoma (PACG)

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11
Q

What is one of the definite TX’s for an acute attack of PACG?

A

Laser Peripheral Iridotomy (LPI)

laser creates microscopic hole in the iris so fluid can enter through hole instead of traveling through pupil

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12
Q

Many acute attacks of PACG happen in __?

What does this cause?

A

Many acute attacks of PACG happen in DARK rooms

Dark rooms cause:
Pupil dilation = increase contact b/w iris + lens = narrowing of angle = attack triggered

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13
Q

What are the 3 types of primary glaucoma?

A
  1. Open Angle
  2. Angle Closure (acute + chronic)
  3. Normal Tension
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14
Q

What are the 6 types of secondary glaucoma?

A
  1. Neovascular
  2. Pigmentary
  3. Phacolytic
  4. Phacomorphic
  5. Uveitic
  6. Trauma-related
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15
Q

What are some of the features of primary open-angle glaucoma?

  • Age?
  • Sxs?
  • IOP?
  • Vision loss?
  • Trabecular mesh network?
A

PAOG

Affects mainly > 50 yo

No sxs / painless

IOP slowly rises (slow vision loss - 1st noticed @ late stages)

No visible damage to trabecular meshwork cells but TMCs lose ability to carry out nml fxn

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16
Q

What are some of the features of normal-tension glaucoma?

A

Progressive optic nerve damage + visual field loss (peripheral)

Normal IOP

In part d/t poor blood flow to optic nerve

17
Q

What are some of the features of primary angle-closure glaucoma?

  • etiology?
  • types?
A

Fluid pressure builds up behind the iris + forces it against trabecular meshwork (blocking it)

When trabecular meshwork blocks completely it l/t PACG

Can be acute or chronic (acute is an emergency + can l/t permanent vision loss)

18
Q

In Chronic Angle Closure Glaucoma the __ gradually closes over trabecular meshwork causing scarring + elevated IOP

A

In Chronic Angle Closure Glaucoma the IRIS gradually closes over trabecular meshwork causing scarring + elevated IOP

19
Q

What are some of the features of pigmentary glaucoma?

  • what kind?
  • age?
  • etiology?
A

Open angle (inherited)

2nd - 3rd decade of life

Irido-zonular contact l/t trabecular meshwork blockage by pigment

20
Q

What are some of the features of pseudo-exfoliative glaucoma?

  • MC amongst?
  • age?
  • etiology?
  • increases risk of?
A

MC among european (scandinavian)

6th - 8th decade of life

Whitish dandruff-like material (protein) builds up + clogs trabecular meshwork

Pseudo-exfoliation syndrome increases chance of POAG + CACG by 6x

21
Q

Most important aspect of diagnosing glaucoma?

emphasized

A

Measure IOP!!! (tonometry)

22
Q

What kind of vision is lost first in glaucoma?

A

Peripheral vision

23
Q

Measuring visual fields in glaucoma patients is an important factor to measure/determine:

A

Measure peripheral vision

Determine extent of optic n. damage

24
Q

Thickness of ___ is a risk factor for developing glaucoma

How can this be measured?

A

Thickness of cornea (thinner cornea = increased risk)

Pachymetry measures central corneal thickness

25
Q

What topical + oral TX’s are available to TX glaucoma?

A

Topical:

  • miotics
  • beta blockers
  • alpha agonists
  • CAI’s
  • prostaglandins
  • Rho kinase inhibitors

Oral: CAI’s

26
Q

What is the etiology of cataracts?

A

Opacification or discoloration of crystalline lens

Oxidative stress of lens l/t opacity of lens i.e. imbalance b/w free radicals + antioxidants

Age (MC), pre-senile (diabetes), trauma, toxic (steroids/miotics/anti-psychotics)

27
Q

What are some secondary etiologies of cataracts?

A

Chronic anterior uveitis

Ionizing radiation

Hx of vitrectomy

Acute angle closure glaucoma

Tumor (ciliary body)

28
Q

____ appearance is seen in juvenile DM w/ cataracts (systemic etiology)

A

Snowflake appearance

29
Q

What are the 4 different types of cataracts?

A
  1. Nuclear
  2. Posterior subcapsular
  3. Cortical
  4. Mature cataract
30
Q

Nuclear cataract p/w ___ discoloration of the lens

A

Nuclear cataracts p/w yellow-brown discoloration of the lens

31
Q

Posterior subcapsular cataract:

  • presentation?
  • age?
  • a/w?
A

P/w opacity near posterior aspect of lens

Age < 50 yo

A/w steroid use, DM, trauma, ocular inflammation

32
Q

Cortical cataract:

-key features?

A
  • spoke-like opacities
  • vacuole or radial opacities
  • expands to anterior + posterior lens
33
Q

Mature cataract is defined as lenticular changes that obscure the view of the ___ segment

A

Posterior segment

i.e. full lens is completely opacified

NERVOUS SYSTEM (5 decks)

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