Ocular Abnormality- Glaucoma 2

Front 1

What is the treatment for POAG?

Back 1

• Medical drugs

• Incisional surgery

• Laser surgery

Front 2

What are the types of drugs used to treat POAG?

Back 2

• Beta blockers (timolol)

• Prostaglandin Analogues

(Latanoprost)

• Parasympathomimetics

(Pilocarpine)

• Adrenoceptor agonists

(Brimonidine)

• Carbonic anhydrase inhibitors

(Acetazolamide)

Front 3

How do beta blockers work?

Back 3

• by blocking B2 receptors in the ciliary epithelium reducing aqueous humour production.

Front 4

Which beta blockers are regarded as non-selective?

Back 4

• Timolol

• carteolol

• levobunolol

• metipranolol

Front 5

Which beta blocker is referred to as cardio-selective?

Back 5

Betaxolol

Front 6

What beta blockers have adverse reactions?

Back 6

• Few

• Rare decreased corneal sensitivity

• Rare conjunctivitis, blepharitis, keratitis

Front 7

What are Beta blockers - adverse systemic reactions (cardiac)?

Back 7

• Blocking β-1 receptors may cause:

– a reduction in heart rate

– reduction in heart contractility

– cardiac failure

– arrhythmias

– syncope

– hypotension

Front 8

What are Beta blockers - adverse systemic reactions (bronchial)?

Back 8

Blocking beta-2 receptors:

• constriction of the bronchioles resulting in

- shortness of breath

- wheezing

- dyspnoea

- bronchospasm

Front 9

What are Prostaglandin analogues mode of action?

Back 9

Latanoprost and travoprost:

Increase in uveo-scleral outflow

Bimatoprost:

increase in both trabecular and uveoscleral outflow

Front 10

What are Prostaglandin analogues adverse reactions?

Back 10

• Increase in brown pigment in the iris- permanent

• darker, longer, curlier or thicker eye lashes

• FB sensation

• Conjunctival hyperaemia

Front 11

How do Parasympathomimetics (Cholinergic Agonists) (Miotics) work?

Back 11

• Lower IOP by stimulating muscarinic receptors on the ciliary smooth muscle, thus opening the trabecular meshwork to increase aqueous outflow

Front 12

What are the adverse reactions to Parasympathomimetics?

Back 12

• ciliary spasm

• headaches

• vasodilation of conjunctival blood vessels

• miotic causes dimming of vision

• break down in the blood/aqueous barrier

• need yearly dilation to prevent permanent miosis

Front 13

How do Adrenoceptor agonists work?

Back 13

Alpha-2 agonists lower IOP by reducing aqueous humour formatiom

• Brimonidine

• Apracloidine

Front 14

What are the adverse reactions to Adrenoceptor agonists?

Back 14

• Conjunctival hyperaemia

Front 15

How do Carbonic Anhydrase Inhibitors work?

Back 15

Lower IOP by blocking the enzyme carbonic anhydrase in the ciliary epithelial cells, thereby reducing aqueous humour formation

Front 16

Name some Carbonic Anhydrase Inhibitors.

Back 16

• Acetazolamide

• Brinzolamide

• Dorzolamide

Front 17

What are the adverse reactions to Acetazolamide?

Back 17

• diuretic during the first few weeks of treatment

• Paraesthesia (tingling in the extremities, especially hands and feet)

• Taste disturbance

• Headache

• Fatigue

• dizziness

• guessing or ringing in the ears

Front 18

What are the adverse reactions to Brinzolamide and Dorzolamide?

Back 18

– Foreign body sensation

– Ocular hyperaemia

– Bitter taste in the mouth

Front 19

What are the combination drugs available in the UK?

Back 19

Xalacom®

– a combination of latanoprost with timolol0.5%

Combigan®

– a combination of brimonidine and timolol 0.5%

Cosopt®

– a combination of timolol 0.5% with dorzolamide 2%

Front 20

When is surgery offered to treat glaucoma?

Back 20

If the risk of losing sight through uncontrolled IOP is greater than the risk of sight loss through surgery, then surgery is offered

Front 21

What are the aims of surgical procedures?

Back 21

• To preserve (and if possible enhance) patients quality of life

• Not going to bring back lost visual field, but if getting patient off topical treatment, that is an improved QoL

Front 22

What is filtration surgery?

Back 22

Creation of a new channel for aqueous outflow

Front 23

What are the glaucoma drainage devices?

Back 23

• Implanted devices that are designed to maintain an artificial drainage pathway

• This procedure is often chosen for patients at high risk of failure with trabeculectomy

Front 24

What types of laser treatment are used to treat gluacoma?

Back 24

• SLT (YAG)

• Cyclodestruction

• Penetrating Surgery

• Non-penetrating surgery

Front 25

What is Angle Closure Glaucoma?

Back 25

• PACG

– Acute, chronic, intermiitent

• Secondary

– Pupil block

– Anterior pulling

– Posterior Pushing

Front 26

What is Primary Angle Closure Glaucoma?

Back 26

Significant obstruction of functional trabecular meshwork by peripheral iris* that results in optic neuropathy

*In absence of secondary pathological process

Front 27

What are the signs and symptoms of acute angle closure?

Back 27

• Symptoms sudden & severe

• Marked pain, follows trigeminal distribution and associated with nausea, vomiting

• Ciliary flush and periph conj congestion (red eye)

• Blurry vision (corneal oedema)

• Mid-dilated pupil

Front 28

What is your management for acute angle closure?

Back 28

Immediate referral

Front 29

What is the clinical assessment for acute angle closure?

Back 29

• Pen torch?

• Van-Herick

• Gonioscopy

Front 30

How does PACG differ from PAC?

Back 30

• Can only be said to have glaucoma persè if there is evidence of optic nerve damage

• PAC is an ocular emergency and presents as an acute episode

Front 31

What is the classification for PACG?

Back 31

• Pupillary block

• Anterior non-pupillary block

– Plateau iris syndrome/ peripheral iris crowding

• Lens-related

• Factors behind the lens

Front 32

What is the mechanism of pupil block?

Back 32

• most common form of PACG

• Pressure of iris on anterior lens

• impedance to flow of aqueous from posterior to anterior chamber

• Iris bombé

Front 33

What is Plateau iris?

Back 33

• Smaller percentage of PACG

• Flat iris extending into AC

• Abnormal insertion of iris into ciliary body &/or anteriorly rotated ciliary body distorting peripheral iris

• Wide open anterior chamber – Iris blocking trabecular meshwork

Front 34

What is pigment dispersion syndrome?

Back 34

• IOP elevation

• GON

• Melanin iris pigment epithelium

• Aqueous

• Deposit in TM

Front 35

What is Pseudoexfoliative glaucoma?

Back 35

• Raised IOP and GON

• Secondary to PXF (syndrome)

• Abnormal protein epithelium anterior segment (lems, CB, iris, S Canal, cornea endo)

• Iris atrophy

Front 36

What is the management for acute closure attacks?

Back 36

Lower IOP

Miotic therapy- break pupillary block

Surgery- iridoctomy