Term
| Which Gender is more at risk for RPB ACG? Which refractive error? |
|
Definition
| Females and hyperopes have an increased risk |
|
|
Term
| In terms of ethnicity, RPB ACG is more common in ______& ___________ but rare in _______________________________ |
|
Definition
| More common in Inuit & Asians but rare in African Americans |
|
|
Term
| What IOP is generally needed before patient will experience halos? |
|
Definition
|
|
Term
| What symptoms do you expect in a first time case of acute angle closure |
|
Definition
blurred vision
halos
Pain
Headache
Photophobia
Eye redness |
|
|
Term
| What symptoms do you expect in a case of chronic angle closure |
|
Definition
| Can be relatively symptom free if it is chronic and develops slowly |
|
|
Term
| Name 2 types of meds that Dr. Lingel mentioned that you should ask about when concerned about angle closure |
|
Definition
| Anti-depressants and cold meds that cause mydriasis |
|
|
Term
| Describe what you should look for on the pupil/iris in case of RPB ACG |
|
Definition
Mid size and fixed pupil (ischemic muscles)
mis-shapen, peaked pupil, sign of anterior synechiae
Iris atrophy
sign of previous iridectomy |
|
|
Term
| Why is refraction part of the examination in the case of non acute RPB ACG |
|
Definition
| In order to make a differential diagnosis between chronic ACG and Effusive glaucoma where RE changes |
|
|
Term
| Name 6 parts of the examination of a patient with suspected RPB ACG |
|
Definition
Pupils
Biomicroscopy
Tonometry
Gonioscopy
Fundoscopy
Refraction if not acute |
|
|
Term
| Type of cataract that is pathognomonic for ACG |
|
Definition
|
|
Term
| Glaucomflecken is caused by damage to the __________ of the lens due to_______________ |
|
Definition
| Glaucomflecken is caused by damage to the epithelial cells of the lens due to high pressure |
|
|
Term
T/F
ACG can cause disc edema |
|
Definition
|
|
Term
| Why is the term 'relative' used in RPB ACG |
|
Definition
| It is relative because there is no firm attachment b/w the iris and pupil, they are just pushed against one another enough to block aqueous flow |
|
|
Term
| Why is it common for RPB ACG to occur in movie theaters |
|
Definition
| The light level is such that the pupils are mid-dilated and thus contact is made b/w iris and lens (when miotic the tissue is stretched and thinner, when fully dilated the iris and lens are not in contact) |
|
|
Term
| Why is RPB ACG more common in older people |
|
Definition
| Because their lenses are larger and therefore closer to the iris |
|
|
Term
| When the channel between the iris and lens is blocked, what is the approximate rate of increase of IOP |
|
Definition
|
|
Term
| 4 Differential Diagnoses of glaucoma with very high pressure |
|
Definition
RPB ACG
Glaucomatocyclitic Crisis
Pseudoexfoliative Glaucoma
Glaucoma associated with ICE |
|
|
Term
| 5 other forms of angle closure glaucoma |
|
Definition
Plateau Iris
Malignant Glaucoma
Mobile lens
Uveal effusion
Neovascular glaucoma |
|
|
Term
| Uveal effusion is most frequently associated with______________________ |
|
Definition
|
|
Term
| Treatment of acute RPB ACG |
|
Definition
Break attach using medical therapy
LPI or Surgical iridectomy
Evaluate other eye |
|
|
Term
| Treatment of Chronic RPB ACG |
|
Definition
LPI or Lensectomy
Evalute other eye |
|
|
Term
| 2 contraindications for use of Oral Carbonic Anhydrase Inhibitors |
|
Definition
Sulfa sensitivity
Kidney disease |
|
|
Term
| What dosage should oral acetazolamide be administered in the case of angle closure |
|
Definition
| 2x 250mg tablets, NOT 1 500mg |
|
|
Term
| Why is a single 500mg tablet of oral acetazolamide not recommended for treatment of Angle closure |
|
Definition
| This is a sustained release med, whereas we want a big dose at once |
|
|
Term
| Name 3 forms of TOPICAL medical therapy to treat angle closure |
|
Definition
Apraclonidine
Beta blocker
Miotics (Pilocarpine) |
|
|
Term
| Mechanism of apraclonidine 1% |
|
Definition
| Reduces aqueous production |
|
|
Term
| Dosage of apraclonidine 1% to treat angle closure |
|
Definition
| 1-2 drops at time of diagnosis, repeat once in 1 hr if necessary |
|
|
Term
| What beta blocker is recommended for patients with pulmonary problems |
|
Definition
| Betaxolol instead of timolol |
|
|
Term
| Dosage of Beta blocker to treat angle closure |
|
Definition
| 1 drop at time of diagnosis, repeat once in 1 hr if necessary, some recommended q12h until LPI |
|
|
Term
| Never use more than __ % pilocarpine because: |
|
Definition
| Never use more than 2% pilocarpine because higher concentrations cause thickening of the iris, which would make the problem worse |
|
|
Term
| Never use more than __ drops of pilocarpine because: |
|
Definition
| Never use more than 4 drops ofpilocarpine because it will increase the thickness of the iris |
|
|
Term
| Dosage of pilocarpine in treatment of angle closure |
|
Definition
| 2% pilo, 1-2 drops every 15-60min, up to 4 drops, treat fellow eye if it is predisposed. |
|
|
Term
| Some say not to use pilocarpine until IOP<_____mmHg because: |
|
Definition
| Some say not to use pilocarpine until IOP <40mmHg because when the pressure is higher the sphincter and dilator are not working so the med will not have any effect |
|
|
Term
| When managing RPB ACG, check IOP every ____ minutes |
|
Definition
|
|
Term
| In management of RPB ACG, what do you do once IOP <20mmHg |
|
Definition
| Perform gonio to ensure the angle is open |
|
|
Term
| What 2 things must be true before a patient with RPB ACG can be released from your office |
|
Definition
| Must have an open angle and lowered IOP |
|
|
Term
| What do you do once the patients IOP is lowered enough and angle is open |
|
Definition
| Maintain on 2% pilo OU qid and prednisolone acetate 1% qid until LPI |
|
|
Term
| When is LPI generally performed, and why this time frame? |
|
Definition
2-7 days later
because the eye is inflamed, LPI will increase inflammation even more
because the iris is thickened and it is difficult to perform an LPI in that condition |
|
|
Term
| What do you do if the IOP is still elevated OR angle is still closed after 1 hour |
|
Definition
| Repeat all topical meds and add oral hyperosmotics |
|
|
Term
| What drug class is not used in treatment of RPB ACG because it causes inflammation |
|
Definition
|
|
Term
| When treating with an oral hyperosmotic, the patient must drink the entire dose with ____ minutes |
|
Definition
|
|
Term
| When treating with an oral hyperosmotic, the patient must not have water within ______ hours of drinking it |
|
Definition
|
|
Term
| When using oral hyperosmotics we expect the IOP to drop in ___ to ____ minutes |
|
Definition
|
|
Term
| Which hyperosmotic is safe for diabetics and which should be used for caution with diabetics |
|
Definition
| Isosorbide 50% is safe, use glycerin 50% with caution |
|
|
Term
| What ratio of hyperosmotic is used (ml:kg or ml:lb) |
|
Definition
2-3 ml/kg
1-2 ml/lb,
so 220 ml covers most adults |
|
|
Term
| Describe the procedure of corneal indentation |
|
Definition
| Indent central cornea for 30 seconds, rest for 30 seconds, then repeat, for 10-15 minutes |
|
|
Term
| What should you do if the pts IOP is still elevated and their angle is closed after 2 hours |
|
Definition
| Patient should be sent for laser gonioplasty |
|
|
Term
| What should be done if the pts IOP is still elevated and angle is closed after 4-6 hours |
|
Definition
|
|
Term
| What is a laser gonioplasty |
|
Definition
| A Large thermal burn on peripheral iris that causes contraction and may open the angle |
|
|
Term
T/F
Laser gonioplasty can be done instead of LPI |
|
Definition
| False, laser gonioplasty is not a cure and LPI must still be performed afterwards |
|
|
Term
| How do you 'pretreat' a rise in IOP after an LPI |
|
Definition
| Iopidine 1-2 hours before the procedure |
|
|
Term
| How do you prevent a transient uveitis following an LPI |
|
Definition
| Pred 1% qid s/p iridotomy |
|
|
Term
| 6 possible complications from LPI |
|
Definition
rise in IOP
transient uveitis
blurred vision (pigment, cells, flare, blood in AC)
hemorrhage
laser damage to other tissues
ghost images |
|
|
Term
| What is the next step when an angle closure attack cannot be broken with gonioplasty or LPI |
|
Definition
|
|
Term
| Where is the incision made with a iridectomy |
|
Definition
|
|
Term
| 3 components of 1 week follow up after LPI |
|
Definition
Check patency of PI
gonio to check angle
tonometry |
|
|
Term
| LPI sites commonly close within ________ weeks |
|
Definition
|
|
Term
| When is a DFE done after LPI |
|
Definition
|
|
Term
| 4 components of he annual exam of a patient with history and ACG and LPI |
|
Definition
Gonioscopy
check patency of PI
DFE
Visual Fields |
|
|
Term
| Is Glaucomatocyclitic crisis generally bilateral or unilateral |
|
Definition
|
|
Term
| Symptoms of Glaucomatocyclitic crisis |
|
Definition
| Usually no pain, but often halos and blur |
|
|
Term
| What age group is commonly affected by Glaucomatocyclitic crisis |
|
Definition
| Usually in young people, after times of stress |
|
|
Term
Which of the following is not a treatment for Glaucomatocyclitic crisis
Topical steroid
Oral indomethacin
Cycloplegic
Ocular hypotensive |
|
Definition
| Cycloplegics are NOT used since they do not develop synechiae |
|
|
Term
| Range of IOP in Glaucomatocyclitic crisis |
|
Definition
|
|
Term
| Does pseudoexfoliative glaucoma tend to be unilateral or bilateral |
|
Definition
| Starts unilateral and becomes bilateral |
|
|
Term
| How do ICE syndromes cause angle closure glaucoma |
|
Definition
| Proliferation of corneal endo and basement membrane over trabecular meshwork |
|
|
Term
| Management of glaucoma secondary to ICE syndrome |
|
Definition
Early-medical therapy-decrease aqueous production
Filtering surgery
Hypertonics for edema
DSEK or PK if edema is significant |
|
|
Term
| Term for condition where iris is very close to angle in periphery but angle appears deep |
|
Definition
| Plateau Iris configuration |
|
|
Term
| One form of angle closure that is NOT due to unequal pressure b/w anterior & posterior chambers |
|
Definition
| Plateau iris-rather due to lens configuration |
|
|
Term
| How is indentation gonioscopy different in Plateau iris vs RPB |
|
Definition
Plateau-increased peripheral pleating, ie. pushes tissue into angle even more
RPB-iris flattens with gonio |
|
|
Term
| Management of Plateau Iris configuration angle closure |
|
Definition
Miotic drops
Laser iridotomy
Gonioplasty
Gonioscopy annually |
|
|
Term
| Another name for Aqueous misdirection syndrome |
|
Definition
|
|
Term
| Name for condition with VERY high IOP with shallow anterior chamber following intraocular surgery |
|
Definition
|
|
Term
| Malignant Glaucoma may occur up to __ ____ following surgery |
|
Definition
| Occur up to 1 year following surgery |
|
|
Term
| Mechanism of malignant glaucoma |
|
Definition
| Unequal pressure forces vitreous forward,which then presses against lens or ciliary processes and prevents aqueous from leaving posterior chamber |
|
|
Term
| Why is pilocarpine not used to treat Malignant Glaucoma |
|
Definition
| Are attempting to tighten up the zonules to pull the lens back, pilo loosens the zonules and will let the lens move forward even more |
|
|
Term
| Name 5 drug types used to treat Malignant Glaucoma |
|
Definition
Phenylephrine 2.5% qid + 1% Atropine qid
Beta blocker qid
Alpha 2 agonists (0.5% apraclonidine) tid
CAI- topical 2% dorzolamide tid or oral acetazolamide 250mg qid
Hyperosmotics |
|
|
Term
| Management of Malignant Glaucoma |
|
Definition
Rule out other causes
Maximum tolerated therapy for 4-5 days
Argon laser ciliary processes
YAG laser anterior hyaloidotomy |
|
|
Term
| Why is argon laser treatment of ciliary processes used to treat malignant glaucoma |
|
Definition
| to damage CB to attempt to decrease aqueous production |
|
|
Term
| What is the goal of YAG laser anterior hyaloidotomy in treatment of malignant glaucoma |
|
Definition
| to try to 'blast' a hole through the vitreous space, hoping to stop aqueous misdirection to the back. |
|
|
Term
| 3 procedures used if patients are unresponsive to initial treatment of malignant glaucoma |
|
Definition
Vitrectomy
Transscleral Cyclophotocoagulation
LPI of fellow eye |
|
|
Term
|
Definition
| Zonules are lax and lens moves forward due to vitreous pressure |
|
|
Term
| How is Mobile lens ACG different from malignant |
|
Definition
| No history of surgery, zonules are just lax, due to things like pseudoexfoliation, marfans etc. |
|
|
Term
| Name a med that should NOT be used to treat mobile lens angle closure |
|
Definition
| Miotics, since they loosen the zonules |
|
|
Term
| Short term management of mobile lens ACG |
|
Definition
| Cycloplegics and IOP lowering meds |
|
|
Term
| Long term management of mobile lens aCG |
|
Definition
|
|
Term
| Describe Uveal effusion Glaucoma |
|
Definition
| Anterior rotation of CB, relaxation of zonules causes thickening of lens and myopia, often associated with medications |
|
|
Term
| Is Uveal effusion generally unilateral or bilateral |
|
Definition
|
|
Term
| Name 3 meds often associated with Uveal Effusion Glaucoma |
|
Definition
Topiramate
Sulfonamides
SSRIs |
|
|
Term
| Management of Uveal Effusion Glaucoma |
|
Definition
Reduce Aqueous production with beta blocker and alpha2agonist
1 % atropine qid
2x250mg acetazolamide
stop causative med with PCP
1% pred |
|
|
Term
| 3 causes of neovascular glaucoma |
|
Definition
Diabetes
CRVO
Ocular Ischemic Syndrome |
|
|
Term
| Short term management of Neovascular Glaucoma |
|
Definition
Decrease aqueous production
Hyperosmotics |
|
|
Term
| Long term management of Neovascular Glaucoma |
|
Definition
|
|
