Glaucoma Overview and Types

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Questions and Answers

What is the classic triad associated with glaucoma?

Decreased IOP, optic nerve damage, and color blindness

Increased IOP, optic nerve atrophy, and visual field loss (correct)

Increased IOP, retinal detachment, and peripheral vision gain

Optic nerve swelling, peripheral vision gain, and night blindness

Which type of glaucoma is characterized by acute episodes of significant eye pain?

Primary open angle glaucoma

Normal tension glaucoma

Chronic angle closure glaucoma

Angle closure glaucoma (correct)

What is the most prevalent form of glaucoma accounting for 90-95% of all cases?

Congenital glaucoma

Secondary glaucoma

Angle closure glaucoma

Primary open angle glaucoma (correct)

Which factor is NOT considered a risk factor for glaucoma?

Young age Signup and view all the answers

Which population group is at a significantly higher risk for developing glaucoma?

Black people Signup and view all the answers

What is the recommended frequency for eye exams in patients older than 40 with a family history of glaucoma?

Every 1-2 years Signup and view all the answers

What visual symptom is commonly associated with open angle glaucoma?

Halos around lights Signup and view all the answers

Which of the following is true regarding angle closure glaucoma?

It can lead to permanent blindness if untreated Signup and view all the answers

Which test is NOT a solitary diagnostic tool for glaucoma?

Single eye drop assessment Signup and view all the answers

What examination findings are typically associated with acute angle closure glaucoma?

Unilateral pain, halos around lights, and nausea Signup and view all the answers

What is the primary goal of glaucoma treatment?

Prevent further nerve damage Signup and view all the answers

What is the preferred first line medication for glaucoma treatment?

Prostaglandin analogs Signup and view all the answers

What percentage reduction in IOP is recommended as a goal in glaucoma treatment?

30% Signup and view all the answers

Which medication can potentially increase intraocular pressure (IOP)?

Corticosteroids Signup and view all the answers

What should patients be educated about regarding their glaucoma medications?

Potential adverse effects and contraindications Signup and view all the answers

Which of the following is a potential treatment option during an acute angle closure attack?

Topical miotic drops Signup and view all the answers

Study Notes

Glaucoma

Glaucoma is characterized by progressive damage to the optic nerve.
The classic triad for glaucoma includes increased intraocular pressure (IOP), optic nerve atrophy, and visual field loss.
Open angle glaucoma is the most prevalent, chronic, and progressive type, causing optic nerve damage and associated visual field loss. Early detection and treatment are crucial for a good prognosis.
Angle closure glaucoma involves acute episodes of significant pain, redness, and acute vision loss. Untreated angle closure glaucoma can lead to permanent blindness.
Primary glaucoma is caused by an ocular condition, while secondary glaucoma arises from a systemic process.
The prevalence of glaucoma is 4-5 times higher in Black individuals than in white individuals, and it is 15 times more likely to cause blindness in Black patients than in white patients.
Primary open-angle glaucoma accounts for 90-95% of all glaucoma cases.
Angle closure glaucoma affects approximately 0.1% of the population, predominantly those aged 50-70 years. It is more prevalent in individuals of Asian and Native Alaskan descent.
Risk factors for glaucoma include increased IOP, family history, older age, African descent, decreased corneal thickness, increased cup-to-disk ratio, medication use (corticosteroids, viscoelastic agents), uveitis, trauma, and intraocular tumors.

Physical Exam

Open angle glaucoma often presents with gradual, slow, painless, bilateral peripheral vision loss, and poor night vision. Later stages may experience halos around lights and further visual field loss.
Acute angle closure glaucoma involves a rapid onset, unilateral pain and pressure, blurred vision, halos around lights, photophobia, loss of peripheral vision followed by central vision loss, headache, and nausea/vomiting.
Chronic angle closure glaucoma has an insidious onset similar to open-angle glaucoma, with patients experiencing vague eye discomfort and intermittent blurred vision.

Diagnostics

Individuals over 40 with a family history of glaucoma should undergo eye examinations every 1-2 years.
Diagnosis requires identifying characteristic degenerative changes in the optic nerve and visual field defects.
Referral to an ophthalmologist is crucial for comprehensive testing, including IOP testing (tonometry), optic nerve examination, visual field testing, and corneal thickness assessment.
It is essential to note that elevated IOP alone is not sufficient to diagnose glaucoma.

Differentials

Other conditions that should be considered in the differential diagnosis include conjunctivitis, uveitis, and medication use (like corticosteroids, amphetamines, and chlorpromazine) that can increase IOP.

Treatment

Referral to an ophthalmologist is necessary for appropriate treatment.
Nerve damage from glaucoma is irreversible.
The primary treatment goal is to prevent disease progression.
Adequate lowering of IOP is crucial, with a target of 30% reduction.
Treatment options include medication eye drops or surgical interventions.
Prostaglandin analogs are often the first-line treatment, administered once daily, known for their efficacy and decreased systemic absorption.
Beta blockers and alpha-agonists are alternative options.
Laser trabeculoplasty(LTP) is a surgical laser therapy, but its effect may only last a few years.
Acute angle closure glaucoma requires immediate intervention with Diamox (acetazolamide), IV mannitol, topical miotics, and laser therapy, followed by bed rest during the the acute attack.

Patient Education

Lifelong follow-up with an ophthalmologist is essential.
Patients require education on the signs and symptoms of worsening glaucoma.
Emphasize the importance of medication compliance, potential adverse effects of glaucoma medications, and contraindications, such as the use of systemic corticosteroids.
Teach patients how to correctly instill eye drops.

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Description

This quiz delves into the different types of glaucoma, focusing on their characteristics, risk factors, and prevalence. Learn about open-angle, angle-closure, primary, and secondary glaucoma, and their impact on vision. Understanding glaucoma is crucial for early detection and effective treatment.