PT11

How would you diagnose glaucoma?

Direct observation of optic nerve, visual field examination, assessment of intraocular pressure, determine open or closed, measure of thickness

Define ophthalmoscopy?

Observation of optic nerve, good for visualising optic nerve for a range of ophthalmic conditions, can provide cross section of optic nerve

Define tonometry?

Checking the pressure inside the eye

Define gonioscopy?

Determine close or open angle, looking at how fluid drains out of the eye

Define low tension?

Pressure under

Define ocular hypertension?

Pressure between 21-23 mmHg regularly check to see if progresses

Define Glaucoma?

Pressure over 23mmHg

Describe the characteristics of primary open angle glaucoma?

Blockage in trabecular meshwork which drains the anterior chamber into the episcleral veins via the canal of Schlemm leading to pressure build up

What are the three types of treatment for primary open angle glaucoma?

Medical, laser, surgical

What are the 2 main types of treatment aims?

Reduce the amount AH produced, increase drainage through trabecular meshwork

Describe the characteristics of prostaglandin analogues in primary open angle glaucoma?

Increase uveoscleral outflow, most effective, can change eye colour due to increase number if melanosomes, change in eyelash length

Describe the choices of prostaglandin analogues?

Bimatoprost most effective then travoprost, then latanoprost, order reversed for side effects and cost, latanoprost discolours soft contact lenses

Describe the characteristics of Beta Blockers in primary open angle glaucoma?

Reduces aqueous humour production

What are some of the contraindications for Beta Blockers in glaucoma?

Bradycardia, diabetes, corneal disease due inducing dry eyes

Describe the characteristics of Carbonic anhydrase inhibitors in primary open angle glaucoma?

Decrease production of intraocular fluid, increase blood perfusion to eye, neuroprotective

Some of the adverse effects of carbonic anhydrase inhibitors?

Weak diuretic effect, contraindicated in renal failure

Which carbonic anhydrase inhibitor is used in closed angle glaucoma?

Acetazolamide due to rapid reduction in intraocular pressures, Oral or IV

Describe the characteristics of sympathomimetics in primary open angle glaucoma?

Work on alpha receptors, decrease AH production and increase out flow

What are the contraindications for sympathomimetics?

Severe cardiovascular disease, side effects blurred vison, discomfort, headache, nausea

Examples of sympathomimetics?

Brimonidine, apraclonidine, iopidine

Describe the characteristics of miotics in primary open angle glaucoma?

Pull iris away from trabecular meshwork, improving out flow, tablets eye drops, injections

What are the contraindications for miotics?

Less well tolerated, has parasympathomimetic effects

Example of miotic drug?

Pilocarpine

What was is the first line treatment for open angle glaucoma?

Generic prostaglandin analogue, try different ones

What is the second line treatment for open angle glaucoma?

The addition of beta blocker if IOP is still too high

Who should treatment for open angle glaucoma not be offered to?

People with OHT who are not at risk of vision impairment within their life

Define Trabeculectomy/trabeculotomy?

Remove part of the eyes drainage tubes, involves electric current, can lead to dry eyes

Define viscocanalostomy?

Remove part of sclera

Define deep sclerectomy?

Widen the drainage tubes

Define trabecular stent bypass?

trabeculoplasty to meshwork

Define iridotomy?

Create holes in iris

What should be given to reduce scaring of the eye?

Antimetabolites

How would reassess patients?

Assess compliance, goldman tonometry for IOP, reassess for visual field defects

What are the symptoms of primary angle closure glaucoma?

Severe pain, headache, change in vision

How to manage primary angle closure glaucoma?

Diuretics, pilocarpine, PGA, b blockers, sympathomimetics, surgery