Term
| What are P Hx risk factors for angle closure glaucoma? |
|
Definition
F HX
Age
Female
Hyperopia
Inuit or Asian ethnicity |
|
|
Term
|
Definition
blur
halos
pain
HA
photophobia
eye redness |
|
|
Term
|
Definition
limbal injection
mid dilated no reactive pupil
IOP range of 40-90 mmHg
Corneal edema
closed angle on gonio |
|
|
Term
| What is a relative pupillary block ACG? |
|
Definition
| Iris in contact with lens at pupil --> adhesion --> higher pressure in posterior chamber --> bulge in peripheral iris --> angle closure |
|
|
Term
| How fast can IOP rise due to RPB ACG? |
|
Definition
|
|
Term
| What are 3 d/dx of RPB ACG? |
|
Definition
glaucomatocyclic crisis
pseudoexfoliative glaucoma
ICE related glaucoma |
|
|
Term
| What are other forms of ACG? |
|
Definition
Plateau iris
malignant glaucoma
mobile lens
uveal effusion
neovascular glaucoma |
|
|
Term
| What is tx for acute RPB ACG? |
|
Definition
LPI or iridectomy
break the attack
evaluate fellow eye |
|
|
Term
| What is tx for chronic RPB ACG? |
|
Definition
LPI or lensectomy
evaluate fellow eye |
|
|
Term
| What is CAI dose for RPB ACG? |
|
Definition
|
|
Term
| What are c/I for CAI use? |
|
Definition
|
|
Term
| What is the dose of apraclonidine for RPB ACG? |
|
Definition
| 1%; 1-2 drops at time of dx; repeat once in 1 hr if needed |
|
|
Term
| What is the dose for timolol/betaxolol in RPB ACG? |
|
Definition
0.5% timolol; 1 drop at dx; repeat in one hr if necessary; continue 1 drop q 12 h until LPI
Betaxolol 0.25% used for patients with pulmonary problems |
|
|
Term
| What is the dose for pilocarpine in RPB ACG? |
|
Definition
pilocarpine 2 %; 1-2 drops q 15-60 m
Do not exceed 4 drops
Useful if IOP > 40mmHg |
|
|
Term
| How often is IOP checked during an RPB ACG crisis? |
|
Definition
| Every 15 minutes until IOP <20 mmHg and gonio confirms open angle |
|
|
Term
| If IOP is still elevated after 1 hr of tx for RPB ACG, what is the next tx option? |
|
Definition
| oral hyperosmotics after repeating all topical meds |
|
|
Term
| What meds should an RPB ACG pt be on until the LPI is performed? |
|
Definition
| 2% pilocarpine QID and prednisolone 1% QID |
|
|
Term
| Are oral hyperosmotics commerically available? |
|
Definition
| No, must be made by pharmacy |
|
|
Term
| How are oral hyperosmotics administered? |
|
Definition
serve over ice, possibly mixed with orange juice
Drink within 5 minutes
No water for 1st 2 hours |
|
|
Term
| What are the effects of oral hyperosmotics? |
|
Definition
IOP drop in 30-60 minutes
Can make the pt sick |
|
|
Term
| What is the dose for oral hyperosmotics? |
|
Definition
2-3 ml/Kg OR 1-2 mL/Lb
220 mL bottle should be enough for most adults |
|
|
Term
| What are the two oral hyperosmotics? Which are DM safe? |
|
Definition
| Isosorbide and glycerin, isosorbide is safe for DM pt's |
|
|
Term
| What gonio procedure can be used to reduce IOP in RPB ACG? |
|
Definition
|
|
Term
| How is corneal indentation performed? |
|
Definition
press gonio into central cornea for 30 seconds, rest for 30 seconds and repeat cycle for 15 minutes
pt may not tolerate due to pain and sensitivity |
|
|
Term
| When should a RPB ACG pt be sent for laser gonioplasty? |
|
Definition
| If IOP still elevated after 2 hours |
|
|
Term
| What is the size of a spot for laser gonioplasty? What kind of laser is used? |
|
Definition
|
|
Term
| Does laser gonioplasty cure RPB ACG? |
|
Definition
| NO, only temporarily opens angle. LPI must still be performed |
|
|
Term
| If IOP is elevated 4-6 hours after angle closure and laser gonioplasty has been performed, what is the next step? |
|
Definition
|
|
Term
| If a pt has one eye develop RPB ACG, are one or both eyes given an LPI? |
|
Definition
| Both, prophylactic for the other eye |
|
|
Term
| What kind of laser has lower rates of LPI closure? |
|
Definition
|
|
Term
| What are LPI complications? |
|
Definition
IOP spike
uveitis
blur from debris in AC
inadvertent laser damage
ghost image if LPI placed poorly |
|
|
Term
| What should be done 1-2 hrs before an LPI is performed? |
|
Definition
| Iopidine to prevent IOP spikes |
|
|
Term
| If an LPI or laser gonioplasty fails to work long term for RPB ACG, what is the next step? |
|
Definition
|
|
Term
| Are RPB ACG pt's ever 'in the clear' regarding glaucoma? Why? |
|
Definition
No, they will always be managed as a glaucoma suspect
LPI may close or POAG can develop from damage to TM; damage to the NFL |
|
|
Term
| What is the f/u schedule for an LPI? |
|
Definition
1-7 days post LPI:
gonio to affirm open angle
tonometry
check LPI patency
At 1,2 and 6 mo:
DFE w/ photos and VF |
|
|
Term
| When is an LPI most likely to close? Least likely? |
|
Definition
Most: 6-8 w
Least: >6 months |
|
|
Term
| What are s/sx of glaucomatocyclitic crisis? |
|
Definition
Young pt's w/ episodic IOP spikes
IOP 40-60 mmHg
unilateral w/ no pain
blur/halos
may be subtle uveitis
minimal conj injection |
|
|
Term
| What is the cause of glaucomatocyclitic crisis? |
|
Definition
| Suspected to be increased prostaglandins, but ultimately idiopathic |
|
|
Term
| What are the three tx's of glaucomatocyclitic crisis? What is NOT necessary? |
|
Definition
topical steroids
ocular hypotensives
oral indomethacin
not necessary to cycloplege |
|
|
Term
| What is the profile of pseudoexfoliative glaucoma? |
|
Definition
Male > female
increased age
starts unilateral --> bilateral
anterior lens/pupillary border deposits
pupillary ruff defects
zonular involvement
TM pigment |
|
|
Term
| How is pseudoexfoliative glaucoma treated? How well does it respond? |
|
Definition
| Treated like POAG, but does not respond as well therefore tx is more aggressive --> opt for surgery sooner |
|
|
Term
| Does pseudoexfoliative glaucoma increase the risk of ACG? |
|
Definition
|
|
Term
|
Definition
iris, corneal, and endothelial dysfxn due to proliferation of corneal endo and basement membrane growth over TM
Iris atrophy and holes due to stretching
Usually 20-40 years old
Broad Peripheral Anterior Synechiae (PAS) |
|
|
Term
| How is ICE syndrome treated? |
|
Definition
decrease AH production pharmaceutically
filtering surgery often required
hypertonics for corneal edema
DSEK or PK if corneal edema is severe |
|
|
Term
| What is plateau iris configuration (ACG)? |
|
Definition
| Iris is close to angle, but not closing it until dilated. Iris pleats --> angle closure |
|
|
Term
| If indentation gonioscopy is performed, how does it differ on plateau iris vs RPB ACG? |
|
Definition
| Indentation increases peripheral pleating in plateau iris; in RPB iris flattens out with indentation |
|
|
Term
| How is Plateau Iris treated? |
|
Definition
|
|
Term
| How is a plateau iris pt managed? |
|
Definition
|
|
Term
| What is malignant glaucoma? |
|
Definition
Serious, poorly responding form of glaucoma
High IOP w/ shallow AC often after ACG surgery
May occur up to one year s/p |
|
|
Term
| What is the mechanism of malignant glaucoma? |
|
Definition
3 proposed:
AH flows into the vitreous
Choroidal expansion raises overall IOP and forces AH from AC
Vitreous face pushes on lens or ciliary processes and prevents AC from leaving PC |
|
|
Term
| What is the tx for malignant glaucoma? |
|
Definition
Phenyl PLUS Atropine
beta blocker
alpha 2 agonists
topical dorzolamide and/or oral dorzolamide
hyperosmotic agents |
|
|
Term
| What is the management for malignant glaucoma? |
|
Definition
Max tolerated medical therapy for 4-5 days
argon laser tx for ciliary processes
YAG laser anterior hyaloidotomy
Vitrectomy
Transscleral cyclophotocoagulation
LPI of fellow eye prophylactically |
|
|
Term
| What is Mobile Lens syndrome? |
|
Definition
Lax zonules allows lens to move forward due to pressure from vitreous face
NOT the same as a subluxed lens |
|
|
Term
| What is the tx for mobile lense syndrome? |
|
Definition
No miotics (loosens zonules further)
cycloplegics and IOP lowering meds short term
lens removal long term |
|
|
Term
|
Definition
Anterior rotation of ciliary body
zonules relax --> thickening of lens --> myopia |
|
|
Term
| What meds can cause uveal effusion? |
|
Definition
topiramate
sulfonamides
SSRI's
bilateral |
|
|
Term
| What is the management for uveal effusion? |
|
Definition
Stop AH production (beta blocker and alpha2 blocker)
atropine
oral acetazolamide 500 mg
Consult w/ PCP to d/c causative med
prednisolone |
|
|
Term
| How long does it take for uveal effusion to resolve? |
|
Definition
|
|
Term
| What is neovascular glaucoma? |
|
Definition
| secondary angle closure due to BV and fibrovascular tissue blocking AC angle |
|
|
Term
| How is neovascular glaucoma managed? |
|
Definition
Decrease AH production
hyperosmotic agent short term
surgery long term |
|
|
Term
| What type of glaucoma is managed with hyperosmotic agents short term but requires surgical long term management? |
|
Definition
|
|
