Ophthalmology Glaucoma

Front 1

Most indicative manifestations of glaucoma:

Back 1

notching> c/d, asymmetry, disc heme > disc asymmetry

Front 2

Rizzuti sign

Back 2

conical light reflection from temporal light source on nasal cornea

Front 3

POAG risks:

Back 3

**thin K's**, FmHx, AfAm, age >50, DM, high myopia, RD, CRVO

Front 4

Acute glaucoma

Back 4

hydropic degeneration & impaired axonal outflowON edema & hyperemia; prior episodesglaukomfleken & ON pallor & cupping

Front 5

Pseudoexfoliation (PXF)

Back 5

age related; build up of abn fibrillar material; 50/50 uni/bilateral; IOPs often higher than COAG; less responsive to meds; Krukenberg spindle; decreased endothelial cell density, pigmented TM, narrow angle, poor dilation, NS, zonular weakness, peripupillary TID, Sampaolesi’s line (pigmented Schwalbe’s line); 20-60% risk of glaucoma; lens extraction=no help

Front 6

Uveitic glaucoma

Back 6

1) inflamm debris obstructs angle 2)hyperviscose Aqueous 3)NV 4) uveal effusion 5)papillary block 6) PAS

Front 7

Increased episcleral venous pressure

Back 7

Sturge-Weber, Graves, AVF, SVC syndrome

Front 8

glaucoma secondary to Malignant melanoma

Back 8

most commonly glaucoma from NVA, esp after radiation; also, TM obstruction by melanin-containing macs, direct tumor extension into TM, angle closure from ant displacement of lens-iris diaphragm or PAS & inflammation

Front 9

Steroid induced

Back 9

?secondary to GAGs accumulating in TM

Front 10

Aqueous misdirection (Malignant)

Back 10

aqueous is misdirected into vit cavity pushing everything forward; flat AC, moderately high IOP; Risk factors: crowded AC (angle closure, nanophthalmos, older, women, hyperopes), post op inflammationswelling of CB & CP; TX=mydriasis/cycloplegics to pull lens-iris diaphragm posteriorly; in pseudophakes, YAG ant hyaloids; VTX

Front 11

Pupillary block

Back 11

shallow AC, mildly inc IOP, peripheral I-K touch; Tx=cyclo, PI, steroids

Front 12

Post trauma glaucoma

Back 12

spontaneous closure of cyclodialysis cleft weeks to months after injury results in a chronic hypotonous eye to have extremely high IOP until TM system “wakes up”

Front 13

Lens particle

Back 13

post trauma or post op residual cortexmay spontaneously resorb

Front 14

Phacoanaphylactic

Back 14

traumaruptured lens capsulegranulomatous inflammation

Front 15

Phacomorphic

Back 15

large crystalline lenspupillary blocksecondary angle closure

Front 16

Phacolytic

Back 16

mature lens leaksmacs attackobstructs TM; TX=lensectomy

Front 17

epithelial downgrowth

Back 17

epi gets to AC following intraocular procedures; Tx=unrewarding; goal=close fistula, excise

Front 18

glaucoma due to scleral buckles

Back 18

interfere w/ venous drainage of uveal tract swelling & ant rotation of CBangle closure

Front 19

Schwartz’s syndrome

Back 19

open angle glaucoma secondary to RRD as outflow is obstructed by pigment (from RPE), GAGs (from photoreceptors) or photoreceptor outer segments; resolves after RD repair

Front 20

nanophthalmos

Back 20

thick scleravenous outflow restrictionuveal effusionsant CB rotationangle closure
involved protruding tissue (ex. Iris) w/ cryo to destroy intraocular epi

Front 21

UGH

Back 21

AC IOL chafes irisuveitis, glaucoma, hyphema; tx=lensectomy

Front 22

Posner Schlossman (glaucomatocyclitic crisis)

Back 22

20-50; unilateral mild or no discomfort +/- blurry VA w/ profound IOP spike that precedes AC rxn (KP + faint flare & mild ciliary flush w/out iris changes) & last hours to weeks & is self-limited; idiopathic; flat stellate KP in inf ½ of K; +synechiae

Front 23

Ghost cell

Back 23

VH + ant hyaloids breakAC candy stripe hyphema

Front 24

Hemolytic glaucoma

Back 24

hemoglobin laden macs block TM

Front 25

Fuch’s HI

Back 25

like Posner Schlossman but w/ iris hypochromia & white iris nodules

Front 26

congenital glaucoma

Back 26

2/3=bilateral, 10%=AR (familial); IOP>21, C/D>0.3 (2.6% normal variant), K diameter > 12.5, open angle w/ ant iris insertion, no other iris abnormality; 5% parental risk w/ future pregnancies & 5% pt passing to kids;
<3mo—presenting symptom=clouding & tearing (eyes typically kept closed)
>3mo—presenting symptom=K enlargement
Prognosis: APD-irreversible; cupping-potentially reversible
secondary myopic shift from globe enlargement;
“Barkan’s membrane” may overlie angle & require incision at time of goniotomy

Front 27

congenital glaucoma--DDx

Back 27

***Diff dx: neural crest dysgenesis (aniridia, peteres, axenfeld-rieger), phakomatoses, metabolic d/o (lowes (UA for protein & aminoacids), homocyst, mucopolysacc), inflamm (cong rubella (IgM), HSV), neoplasm (Rb, JXG), X-linked megalocornea, downs, pataus, zellweger, rubinstein-Taybi, PHPV, ROB, trauma, steroid use

Front 28

Haab’s striae:

Back 28

horizontal Descemets breaksdue to congenital glaucoma