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Glaucoma
Ocular Disease III Exam 1
203
Medical
Graduate
01/10/2013

Additional Medical Flashcards

 


 

Cards

Term
Name 5 aspects/characteristics of the eye that are glaucoma risk factors
Definition

IOP

Characteristics of Optic Nerve Head

Nerve Fiber Layer

Chamber Angle

Corneal Thickness

Term
5 Nerve head characteristics/changes that may be indicative of glaucoma
Definition

Cup excavation

Rim tissue loss

Vertical cup elongation

Assymetric C/Ds

Peripapillary atrophy

Term
How may corneal curvature affect GAT readings?
Definition

steeper cornea=falsely high reading

Flatter cornea=falsely low reading

Term
How may corneal thickness affect tonometry readings?
Definition

Thicker cornea=falsely high IOP reading

Thinner cornea=falsely low

Term
Only disc change that is completely diagnostic of glaucomatous damage
Definition
progressive thinning of neural rim
Term
Average disc diameter in mm
Definition
1.5 mm average
Term
What is the C/D ratio where risk of glaucoma increases?
Definition
0.6
Term
How much difference in C/D ratios between eyes is suggestive of glaucoma?
Definition
Difference of only 0.1
Term
How may refractive surgery affect tonometry readings?
Definition
Since the cornea is permanently thinner it may give falsely low readings
Term
Name 3 possible explanations for depigmentation of the peripapillary region
Definition

Glaucoma

High myopic atrophy

normal variation

Term
What areas around the optic disc most commonly have brightest and thickest nerve fiber layer?
Definition
In the superior and inferior arcades around the optic disc
Term
Most obvious NFL defect
Definition
Inferior temporal wedge defect
Term
 flame-shaped hemorrhage crossing the optic nerve edge, highly characteristic of glaucoma
Definition
Splinter/Drance Hemorrhage
Term
Which type of glaucoma are Drance hemorrrhage's particularly indicative of?
Definition
Normotensive glaucoma
Term
Common location for splinter hemorrhages
Definition
Inferior temporal disc margin, but can be anywhere around disc rim
Term

Standard instrument for visual field evaluation...?

Standard tests...?

Definition

Humphrey perimeter

30-2 and 24-2 Threshold tests are standard

Term
Describe the first field defects usually detected in glaucoma
Definition
relative paracentral scotomas between 5 and 20 degrees of fixation
Term
Describe how visual field defects tend to progress in glaucoma
Definition
the areas of depressed sensitivity enlarge and deepen along the arcuate nerve fibers until they coalesce and join the blind spot (arcuate defect)
Term
How may blue-yellow visual field defects compare to white-white defects?
Definition
B/Y deficits may precede W/W VF losses by 3-4 years, but B/Y does not take media opacities into account. 
Term
Which ganglion cells are targeted with Frequency Doubling Technology
Definition
Magnocellular Cells (Large diameter)
Term

 

Which instrument is a laser scanning ophthalmoscope in which low-intensity polarized light is used to measure the polarization properties of the bifringent nerve fiber layer to calculate its thickness

 

Definition
GDx Nerve Fiber Layer Analyzer
Term
Which instrument can image layers of the eye using light waves
Definition
Optical Coherence Tomography
Term
Name some situations where initiation of glaucoma treatment is indicated
Definition

POAG in one eye, ocular hypertension in the other

Ocular hypertension in one or both eyes

High IOP (most say over 30)

Progressive rise in IOP

Risk factors and Ocular HTN

Monocular and Ocular HTN suspect

Hx of Retinal Vascular Occlusive Dz with IOP >21mmHg

Term
3 Factors that contribute to IOP
Definition

Aqueous secretion

Outflow resistance

Epscleral venous pressure

Term
What is responsible for 80% of aqueous secretion
Definition

active secretion by non-pigmented ciliary epithelium

 

Term
What is responsible for 20% of aqueous secretion
Definition

ultrafiltration

diffusion

(passive secretion)

Term
Describe the pathway responsible for 80-90% of aqueous outflow
Definition

Trabecular

TM -->Schlemm's canal-->collector channels

-->episcleral veins

Term
Describe the pathway of aqueous outflow responsible for 10-20% of outflow
Definition

Uveoscleral Outflow


Tissues of chamber angle--> thu ciliary muscle --> supraciliary space -->suprachoroidal space -->sclera

Term
Name 3 pathogenesis theories of glaucoma
Definition

1) direct mechanical damage to axons due to IOP

2) Raised IOP causes ischemia and subsequent nerve fiber death

3) Genetic propensity to apoptosis

Term
3 Main pharmocological glaucoma treatment mechanisms
Definition

Reduced aqueous production

Increased aqueous outflow

Neuroprotection

Term
Name 3 drug types used to decrease aqueous production
Definition

beta blockers

alpha-2 agonists

CAIs

Term
Name 4 drug types used to increase aqueous outflow
Definition

Miotics

Adrenergic/alpha-2 agonists

prostaglandins/prostamides

Docosanoids

Term
What must happen to beta receptors for tachycardia and increased cardiac output?
Definition
stimulation of beta 1 receptors
Term
what must happen to beta receptors for bradycardia and decreased cardiac output
Definition
blocked beta 1 receptors
Term
what must happen to beta receptors for bronchial dilation to result
Definition
stimulation of beta 2 receptors
Term
what must happen to beta receptors for bronchoconstriction/spasm to result
Definition
blocked beta 2 receptors
Term
Name the only Beta 1 selective beta blocker discussed in class for glaucoma treatment
Definition
Betaxolol
Term
Which beta blocker is the gold standard?
Definition
Timolol
Term
Which topical beta blocker has the longest half life
Definition
Levobunolol
Term
Which topical beta blocker creates risk of uveitis?
Definition
Metipranolol (Optipranolol)
Term
Which topical beta blocker also has intrinsic sympathomimetic activity?
Definition
Carteolol (Ocupress)
Term
What is the general application regimen for topical beta blockers
Definition
1 drop BID, however QD may be enough
Term
Mechanism of topical beta blockers used to treat glaucoma
Definition
block the beta receptors in the ciliary body to reduce aqueous production
Term
 CNS side effects of beta blockers
Definition

Depression (most common)

Fatigue

decreased libido

headaches

hallucinations (rare)

dizziness

Term
which topical beta blockers tends to cause the least CNS side effects
Definition
Carteolol, due to less blood brain barrier crossing
Term
Name 3 Ocular side effects of topical beta blockers
Definition

stinging/burning

blurred vision

superficial punctate keratitis

Term
4 Heart side effects of beta blockers
Definition

Bradycardia

arrhythmia

palpitation

congestive heart failure

Term
2 hematological side effects of beta blockers
Definition

disrupt lipid levels (except Carteolol)

masks hypoglycemia

Term
3 possible lung side effects of beta blockers
Definition

Bronchospasm

restricted breathing

respiratory failure

Term
4 Contraindications for Beta Blockers Treatment
Definition

Bronchial obstruction/asthma

Chronic Obstructive Pulmonary Disease

Bradycardia/Congestive Heart Failure

Uncontrolled Diabetes/Hyperlipidemia

Term
Name 3 things that must be checked before treating a patient with a beta blocker
Definition

Blood Pressure

Pulse 

Respiration

Term

T/F

Systemic Beta blockers can lower IOP

Definition
True
Term
Name 2 drugs found in CoSopt
Definition
Dorzolamide 2% and Timolol 0.5%
Term
Compare reduction in IOP using Dorzolamide vs. Cosopt
Definition

Dorzolamide (Trusopt)=15-20%

Cosopt=30-35%

Term
Name 1 advantage of using Brinzolamide over dorzolamide
Definition
less sting/burn
Term
Name 2 systemic CAIs
Definition

Acetazolamide

Methazolamide

Term
Light blue cap indicates what concentration 
Definition
0.25%
Term
Yellow cap indicates what concentration
Definition
0.50%
Term
Which beta blocker tends to have the least sting
Definition
Carteolol
Term
1 advantage and 1 disadvantage of Methazolamide compared to acetazolamide
Definition
Methazolamide has less side effects, however it is more expensive
Term
2 indications for use of systemic CAIs 
Definition

eg. Acetazolamide or Methazolamide

Angle Closure glaucoma (emergency)

Complex glaucoma that does not respond to other treatment

Pseudotumor Cerebri

Term
4 Ocular side effects of CAIs
Definition

Superificial punctate keratitis

Ocular allergy

Sting/burn/discomfort

Decreased Endothelial Cell Fxn

Term
Side effects of CAIs
Definition

bitter taste/loss of appetite

sulfa allergies

Dyscrasias

headaches

nausea

fatigue

urolithiasis

tinnitus

paresthesias

electrolyte disturbances

 

Term
4 Contraindications for CAIs
Definition

Sulfa allergy

Sickle cell anemia/other blood dyscrasias

Corneal surgery

Corneal Epithelial/Endothelial Disease

Term
Why is dipivefrin better than normal epinephrine?
Definition
It has increased lipid solubility and thus it penetrates 17x better than epinephrine
Term
Dipifevrin is a prodrug that converts to which substance?
Definition
Epinephrine
Term
Which receptors are affected by dipivefrin
Definition
Alpha and beta receptors (adrenergic) are directly stimulated
Term
3 Cardiovascular side effects of dipivefrin
Definition

Tachycardia

arrhythmias

Hypertension

Term
Ocular Side effects of Dipivefrin
Definition

Pupil dilation

Irritation

Adenochrome deposits

Lacrimation

Initial elevation of IOP

Cystoid Macular Edema

Term
2 Contraindications for propine (epinephrine) and the reason for them
Definition

Aphakes

Pseudophakes

Due to risk of Cystoid Macular Edema

Term
Mechanism of Apraclonidine
Definition
Stimulates alpha 2 receptors, resulting in reduced aqueous production and increased uveoscleral outflow
Term
Concentration and dosage of apraclonidine ophthalmic solution
Definition
0.5% solution TID
Term
Which drop is used in treatment of post-surgical IOP spikes?
Definition
Apraclonidine, will help get the pressure down quickly and has a short term effect
Term
Give 1 reason why brimonidine is better than apraclonidine
Definition
less Tachyphylaxis
Term
Why are alpha 2 agonists contraindicated in children
Definition
Can cause fatal heart arrhythmias
Term
2 contraindications for alpha 2 receptor stimulators
Definition

MAO Inhibitors

Heart Disease

Term
Name 3 Adrenergic agonists used to increase aqueous outflow
Definition

Dipivefrin

Apraclonidine

Brimonidine

 

Term
Nam2 cholinergic agonists (miotics) used to increase aqueous outflow
Definition

Pilocarpine

Carbachol

Term
Name 3 prostaglandins/prostamides used to increase aqueous outflow
Definition

Latanoprost

Travoprost

Bimatoprost ('mide)

Term
Name 4 Hyperosmotics
Definition

Glycerol

Mannitol

Isosorbide

Urea

Term
Side effects of brimonidine (alphagan)
Definition

Hyperemia

Sting/burn/FB

blur

dry mouth

headache

fatigue/lethargy

Term
Name 2 drugs found in Combigan
Definition

Brimonidine (0.2%)

Timolol (0.5%)

Term
What is a disadvantage found with the use of Combigan
Definition
It is not as effective in lowering IOP as using both brimonidine and timolol separately
Term
Name 3 forms of pilocarpine available for glaucoma treatment
Definition

0.25-10% solutions

4% gel

1-3% Membrane solution (slow release)

Term
How many times a day is pilocarpine administered
Definition
QID
Term
3 types of glaucoma that pilocarpine is indicated for
Definition

POAG

Angle closure

Pigmentary

Term
8 Ocular SE of pilocarpine
Definition

Decreased night vision due to miosis

VF constriction

Myopia

fluctuating vision

Browache

Retinal detachment for some pts

Pupillary block

blood-aqueous barrier breakdown

Term
Systemic side effects of pilocarpine
Definition

salivation

perspiration

hypotension

bradycardia

bronchospasm

abdominal pain

diarrhea

nausea/vomiting

headache

Term
Pilocarpine Contraindications
Definition

<40 yo

Retinal detachment history

high myopia

lattice/holes/breaks

cataracts

inflammatory/uveitic/neovascular glaucoma

 

Term
Why is pilocarpine contraindicated for inflammatory/uveitic/neovascular glaucomas?
Definition
It increases the surface area and subsequently exacerbates the inflammation. 
Term
Which other glaucoma medication does not work well with pilocarpine
Definition
Prostaglandins like Latanoprost (Xalatan)
Term
4 uses of pilocarpine discussed in class
Definition

Glaucoma tx

Diagnose Adie's pupil

Diagnosis of fixed pupil

possibly treatment of accommodative esotropia

Term
Single most effective category of glaucoma medication
Definition
Prostaglandins
Term
First choice drug in glaucoma tx
Definition
Latanoprost (Xalatan)
Term
Why are pilocarpine and latanoprost not used together
Definition

They counteract one another, 

latanoprost opens up the ciliary body spaces while pilocarpine constricts it

Term
2 Drugs founds in DuoTrav (Canadian)
Definition
Latanoprost and Timolol
Term
Compare Latanoprost (Xalatan) with Travaprost (Travatan)
Definition
Travatan=no refrigeration, same side effects but lower risk of them (uveitis)
Term
2 Meds found in Extravan (pending)
Definition
Travaprost and Timolol
Term
Difference b/w Travatan and Travatan Z
Definition
Z version has no benzalkonium chloride (BZK)
Term
Name the prostamide drug used in glaucoma treatment
Definition
Bimatoprost (Lumigan)
Term
2 Concentrations bimatoprost comes in and the difference?
Definition

0.03%

0.01%-more BZK in it

Term
Latisse is a formulation of which glaucoma medication
Definition
Bimatoprost (Lumigan)  0.03%
Term
First preservative free prostaglandin analogue
Definition

Tafluprost (Zioptan) 0.0015%

Saflutan in Europe

Term
Which drug class has a side effect of darkening ocular tissues?
Definition
Prostaglandins
Term
Side effects of prostaglandins
Definition

>Darkening of:

-iris

-lashes/periocular hair

-eyelids

>CME in aphakes/pseudophakes

>Uveitis

>Herpes virus reactivation

Term
Prostaglandin contraindications
Definition

aphakia

recent pseudophakia

History of uveitis or herpes simplex

YAG laser

cosmesis

cost

Term
Which hyperosmostic is contraindicated for diabetics?
Definition
Glycerol
Term
Which 2 Hyperosmotics are via IV administration
Definition

Mannitol

Urea

Term
Indications for hyperosmotics
Definition

High IOp >40mmHg

Angle closure

Term
What is the Ocugene test used for?
Definition
Uses DNA to determine one's risk for developing glaucoma. 
Term
Steroids may be used to treat what type of glaucoma?
Definition
Inflammatory glaucoma such as uveitic or chemical burn glaucoma. 
Term
Name 2 Steroids that have less propensity to increase IOP compared to other steroids
Definition
Lotemax (Loteprednol) and FML
Term
Name 3 options for initial glaucoma treatments including dosage
Definition

1. Beta blocker QD

2. Brimonidine BID

3. Prostaglandin HS

Term
At what point in glaucoma therapy is an Oral CAI considered?
Definition
As a last resort after other medications and surgeries have failed to control the disease. 
Term
2nd step in therapeutic flow chart for glaucoma therapy (after using a single drop)
Definition

Combination of 2 of either a beta blocker, brimonidine or prostaglandin

OR

add docosanoid 

Term
3rd step in glaucoma treatment
Definition
Add a topical CAI TID monocular
Term
4th step in glaucoma therapy
Definition
Surgery= LTP or trabeculectomy
Term
How often do you need to see your stable glaucoma patient?
Definition
Minimum-every 3 months
Term
How is laser treatment of POAG expected to affect IOP?
Definition
Initial spike, then 8-10mmHg drop 6-8 weeks later
Term
How is SLT different than ALT or LTP 
Definition

ALT and LTP cause permanent, scarring damage to the trabecular meshwork

SLT does not scar as much and is repeatable 

Term
Prognosis of POAG after laser treatment
Definition

still need glaucoma meds 

Only keeps IOP down for about 5 years

 

Term
Difference b/w sclerostomy and trabeculectomy
Definition

Sclerostomy is a full scleral channel

Trabeculectomy is a partial scleral channel

Term
Name 2 post-surgical drugs that may be given to prevent scarring 
Definition
5-fluorouracil and mitomycin 
Term
Risks involved with 5-FU and Mitomycin
Definition

risk of hypotony (low pressure)

risk of wound leak (reduced healing)

risk of endophthalmitis

risk of encapsulated bleb

Term
2 types of end-stage glaucoma surgery 
Definition

Cyclocryotherapy-permanently freezing ciliary body

Transcleral YAG laser Cryophotocoagulation-use laser to damage ciliary body epithelium

Term
Flow of glaucoma surgery options (from first option to end stage)
Definition

ALT/SLT

Trabeculectomy

Tube shunt

Cyclocryotherapy

Term
Name the 4 main classifications of glaucoma
Definition

Primary Open Angle

Primary Closed Angle

Secondary glaucomas

Developmental glaucomas

Term
What is the most common form of adult glaucoma
Definition
POAG
Term
Order the structures seen with gonioscopy starting with ciliary body
Definition

Ciliary body

Scleral spur

Trabecular meshwork

Schwalbe's line

Term
Visibility of what structure in gonioscopy indicates an open angle
Definition
Ciliary Body
Term
Which structure obstructs the outflow of aqueous in cloased angle glaucoma
Definition
root of the iris
Term
Difference between pigmentary dispersion syndrome and pigmentary glaucoma
Definition

Pigment accumulation in the TM

PDS=no optic neuropathy

PG=with optic neuropathy

Term
Rate of conversion of PDS to PG
Definition
30-50%
Term
2 theories of pathophysiology of pigmentary dispersion syndrome/glaucoma
Definition

1. Abnormal iris pigment epithelium results in dispersion

2. rubbing of the iris pigment epithelium against lens or zonules results in release

Term
Age range of Pigmentary glaucoma
Definition
20-40 yo
Term
PDS is most common in which race
Definition
Caucasians
Term
PG is more common in which gender?
Definition
Males
Term
2 Ocular characteristics that tend towards developing PDS earlier
Definition

Myopia

Deep angles

Term
3 symptoms caused by Rapid IOP elevation
Definition

Pain

Intermittent blurry vision

Halos around lights

Term
Classic triad of diagnosis of pigmentary glaucoma
Definition

Krukenberg spindle

Iris transillumination defects

Pigment deposition in the TM

Term
Vertical accumulation of pigment on the central corneal endothelium
Definition
Krukenberg spindle
Term
Location of iris transillumination defects due to pigmentary dispersion
Definition
Mid peripheral
Term
Pigment observed on or anterior to Schwalbe's line
Definition
 Sampaolesi's Line
Term
4 locations where pigment may be found in pigmentary dispersion syndromes
Definition

Anterior Iris

Corneal endothelium

Lens zonules

Lens capsule

Term
2 gonioscopy findings associated with pigmentary dispersion
Definition

Pigment on TM

concavity of mid-peripheral iris

Term
2 causes of pigment liberation
Definition

Strenuous exercise

Pupil Dilation

Term
4 DDx for Pigmentary Glaucoma
Definition

Exfoliation syndrome

Uveitis

Ocular melanosis

POAG with excessive pigmentation

Term

POAG vs. PG

In which is IOP generally more difficult to control?

Definition
PG
Term
Most common identifiable form of secondary open angle glaucoma
Definition
Pseudoexfoliation glaucoma
Term
Disease characterized by gray-white granular flakes depositing throughout anterior chamber accompanied by increased IOP and/or changes in VF and optic nerve 
Definition
Pseudoexfoliative glaucoma
Term
Name 3 possible sources of pseudoexfoliation material
Definition

iris pigment epithelium

ciliary epithelium

peripheral anterior lens epithelium

Term
Most common age of onset of PXS/PXG
Definition
60-80
Term
What ethnicity has a high rate of developing PXS/PXG
Definition
Older Navajo Indians
Term
Approximate rate of conversion from PXS to PXG
Definition
approx. 15%  after 10 years
Term
Describe the 3 zones on the lens in pseudoexfolation
Definition

Central Translucent Zone in pupillary area

Clear intermediate zone due to iris rubbing

Peripheral granular zone with dense deposits

Term
A common clinical feature of PXS due to weakened zonules
Definition
Lens subluxation
Term
PXS patients are more prone to what ocular condition
Definition
Cataracts, (NS)
Term
Pattern of iris defects common in PXS/PXG
Definition

Pupillary ruff defects, 

Moth eaten in peripupillary and sphincter regions

Term
3 Features of the cornea in PXS/PXG
Definition

Clumps of PXM on endothelium

Krukenberg spindle

decreased endothelial cell count

 

Term
DDx for Pseudoexfoliation 
Definition

Pigment dispersion

True exfoliation

Uveitis

POAG with excessive pigmentation

 

Term
Advantage of selective laser trabeculoplasty compared to argon laser trabeculoplasty
Definition
Equal efficacy but is repeatable, ALT is not repeatable
Term
Increased concentration of this substance in tears and plasma has been correlated with PXG
Definition
Homocysteine
Term
2 substances used to reduce homocysteine concentrations in PXG
Definition

B12

Folic acid

Term
Most common cause of neovascular glaucoma
Definition
RETINAL hypoxia or ischemia results in the release of angiogenic factors
Term
2 clinical terms for new vessels on the iris
Definition

Neovascularization of the iris (NVI)

Rubeosis irides (RI)

Term
Clinical term for angiogenic factor
Definition
Vascular Endothelial Growth Factor (VEGF)
Term
90 Day glaucoma
Definition
Development of Neovascular glaucoma following Central Retinal Vein Occlusion, usually happens 90 days after
Term
Name 8 disorders that predispose patients to neovascular glaucoma
Definition

Central Retinal Vein Occlusion

Diabetic Retinopathy

Carotid Artery Disease

CRAO

Uveitis

Long standing retinal detachment

Intraocular tumors

Carotid cavernous fistula

Term
What test is used to differentiate ischemic vs. nonischemic CRVO
Definition
Fluorescein Angiography
Term
Which disorder has the highest rate of developing neovascular glaucoma
Definition
Central Retinal VEIN Occlusion
Term
Which is more likely to lead to neovascular glaucoma CRVO or CRAO?
Definition
CRVO (36% vs 18%)
Term
Describe the earliest sign of NVI
Definition
fine, tortuous tufts of vessels on the surface of the iris
Term
What slit lamp magnification is needed to see early signs of NVI
Definition
25-40X MAgnification
Term
What needs to be done to ensure pseudoexfolation of the lens is visualized and caught?
Definition
Dilation and then examination of the lens
Term
Why is it important to gonioscopy in addition to SLE on diabetic patients?
Definition
neovascularization can sometimes appear in the angle before the iris/pupillary margin
Term
Visualizing a red flush on TM when performing gonioscopy may indicate what?
Definition
Neovascularization of the angle
Term
Late phase of neovascular glaucoma
Definition

Fibrovascular membrane within the angle contracts, creating a peripheral anterior synechiae (PAS).

This synechiae pulls over the TM and causes angle closure

Term
What other sign may accompany vascular proliferation in neovascular glaucoma?
Definition
Cells and flare
Term
DDx of Neovascular Glaucoma
Definition

Any condition that causes NVI regardless of retinal condition

Post-surgical dilation of iris vessels

Uveitis (causes dilation of vessels)

Fuch's heterochromic iridocyclitis

Intraocular inflammation

Acute angle closure glaucoma

Congenital iris tufts

Lightly pigmented irides

Term

3 Aspects of a Good Neovascular glaucoma workup

 

Definition

High Mag SLE

Gonioscopy

Iris/angle angiography

Term
Key to successful management of neovascular glaucoma
Definition
EARLY DETECTION
Term
3 substances used to treat neovascular glaucoma
Definition

Topical steroids (inflammation)

Anti-VEGF

IOP control meds

Term
3 Procedure options to treat Neovascular glaucoma
Definition

Panretinal Photocoagulation (PRP)

Panretinal Crytherapy

Filtering surgery

Term
When would Panretinal crytherapy be used rather than panretinal photocoagulation?
Definition
Use cryotherapy in cloudy media and when PRP has failed
Term
Name 2 methods that have shown to be effective when used as combination therapy for Neovascular Glaucoma
Definition

Anti VEGF + PRP

PRP 1 week after ANTI-VEGF

Term
4 Options for the painful blind eye with uncontrolled IOP
Definition

Continued meds

cyclodestruction

Retrobulbar alcohol injection

Enucleation

Term
Which gender is more at risk for ACG
Definition
Females
Term
Which refractive error is more at risk for ACG
Definition
Hyperopes
Term
Risk for ACG increases with age until what event (which reverses the risk)
Definition
Cataract surgery
Term
8 Clinical Features of ACG
Definition

Circumferentially closed angle

peripheral anterior synechiae

posterior synechiae

Glaucomflecken

Iris torsion

Iris atrophy

Disc edema

Optic atrophy

Term
2 forms of acute angle closure
Definition

With pupil block

Without pupil block

Term
Signs & symptoms of acute angle closure glaucoma with pupil block
Definition

Severe eye pain

Headache

Blurry vision

Corneal edema

narrow angle

fixed, mid-dilated pupil

IOP>40

Nausea & vomiting

Term
4 Anatomic sources of iris apposition of the TM in ACG 
Definition

Iris

Ciliary body

Lens (phacomorphic)

Posterior to the lens (malignant glaucoma)

Term
Differentiate the iris configuration in ACG with pupil block vs. without pupil block
Definition

With block=iris bombe (peripheral iris adheres to cornea or TM)

without block=plateau iris (last iris roll is bunched against TM)

Term
Iris appearance seen with gonioscopy on a plateau iris
Definition
Double hump or sine wave appearance
Term
What age group and gender does Plateau Iris tend to occur in?
Definition

Young patients (younger than POAG)

Females

Term
Which anatomic abnormality is thought to correlate with  plateau iris
Definition
Large or anteriorly positioned ciliary processes
Term
First treatment of plateau iris
Definition
Laser Peripheral Iridotomy (LPI aka PI)
Term
Clinical term for patients with persistent occludable angle  after peripheral iridotomy has been performed
Definition
Plateau Iris Syndrome
Term
Treatment for plateau iris syndrome
Definition
Laser iridoplasty-peripheral laser burns shrink iris and pull it away from angle
Term
Options for Iris plateau syndrome after unsuccessful laser iridoplasty
Definition

Trabeculectomy

Tube-shunt

Term
Term for angle closure glaucoma caused by swelling of the lens which leads to a shallow anterior chamber
Definition
ACG secondary to phacomorphic glaucoma
Term
Term for ACG due to posterior misdirection of aqueous into vitreous, the lens-iris diaphragm is pushed forward
Definition
ACG secondary to Malignant Glaucoma
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