All MCQs about Glaucoma

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Introduction:

  1. Glaucoma is the MC cause of blindness in developed countries (in India/ World: Cataract).

 

Visual field defects in glaucoma:

  1. Earliest visual field defect in glaucoma: Isopter contraction
  2. Earliest visual field defect in primary open angle glaucoma: isopter contraction
  3. Earliest visually significant visual field defect in glaucoma: Paracentral scotoma
  4. First visual field affected in glaucoma: Superior (as inferior ganglion cells die first)
  5. Sequence of field defect in glaucoma: Paracentral → Seidel → Arcuate → Ring scotoma
  6. Frequent change of presbyopic glasses is an early symptom of open angle glaucoma.

Management:

  1. DOC for POAG/ PACG is prostaglandin analogues
  2. DOC for Acute angle closure/ Acute congestive glaucoma is Pilocarpine
  3. In acute angle closure, vertically mid dilated pupil is seen
  4. Uveitis with raised IOP is best managed by Steroids
  5. Raised IOP in uveitis is managed using Timolol
  6. Pilocarpine is C/I in uveitis
  7. Mechanism of antiglaucoma drugs:
    1. PGF2α analogues: ↑Uveoscleral outflow
    2. α2 agonists: ↓Aqueous production
  8. Important side effects of antiglaucoma drugs:
    1. LatanoprostEyelid pigmentation
    2. Brimonidine – Drowsiness
    3. Timolol – Blepharoconjunctivitis
    4. Dipivefrine – Follicular conjunctivitis.
  9. Brimonidine has neuroprotective action but it is C/I in children as it causes CNS suppression and sleep apnea
  10. Epinephrine can’t be used in aphakic glaucoma because it causes Cystoid macular edema in aphakics
  11. Atropine is contraindicated in all types of glaucoma except in malignant glaucoma where it is DOC (Atropine helps to open the block so that aqueous starts flowing anteriorly)
  12. Triple procedure consists of:
    1. Extracapsular cataract surgery
    2. PCIOL implantation
    3. Glaucoma filtering operation.
  13. Express implant used in glaucoma are made of stainless steel.

 

  1. Inverse glaucoma is seen in microspherophakia (a developmental abnormality in which the lens is small in diameter and spherical, MC condition where it is seen: Weill-Marchesani syndrome)

 

  1. “100 day glaucoma” is seen in central retinal vein occlusion (CRVO)

 

Congenital glaucoma:

  1. Barkan’s membrane is thought to cause congenital (= infantile) open angle glaucoma by blocking the openings of trabecular meshwork
  1. Earliest symptom in congenital glaucoma: Photophobia
  2. Most common symptom in congenital glaucoma: Watering
  3. In congenital glaucoma, Cupping of optic disc is reversible upto 2 yrs of age once IOP is normalized
  4. Treatment of choice in congenital glaucoma: (Trabeculotomy + Trabeculectomy) > Goniotomy

 

Secondary glaucoma:

  1. MC complication of anterior uveitis/ iridocyclitis – Secondary open angle glaucoma
  2. Most common type of secondary glaucoma is pseudoexfoliative glaucoma

 

  1. Phacolytic glaucoma occurs due to leakage of high molecular weight lens proteins through the degenerated capsule of hypermature Morgagnian cataract
  2. Lens particle glaucoma is due to penetrating trauma which ruptures the lens capsule and lens material escapes out
  • The key difference is the history of trauma and status of lens capsule (leaky but intact in phacolytic glaucoma; ruptured in lens particle glaucoma)

 

  1. Phacomorphic glaucoma is the term used for secondary angle-closure glaucoma due to lens intumescence (Causes: advanced cataract/ rapidly intumescent lens/ traumatic cataract)
  2. Pigmentary glaucoma:
    1. Pigment accumulation in the trabecular meshwork reduces aqueous outflow facility and may result in elevation of IOP
    2. It is common in males and myopics
    3. Characteristic feature: Krukenberg spindle (pigment along the corneal endothelium).

 

  1. Vogt’s triad: Evidence of previous attack of angle closure:
  1. Iris atrophy
  2. Glaukomflecken
  3. Pigment deposition in endothelium.
  • Glaukomflecken is grayish-white anterior subcapsular lens opacities that occur following an episode of markedly elevated IOP.

 

Halos in glaucoma:

  1. History of colored halos is never present in steroid induced glaucoma
  2. Fincham test is used for differentiating halos of angle closure glaucoma & immature cataract.

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