Sunday, 17 October 2010

MRCP revision battle 32.6: Glaucoma

Glaucoma is damage to the optic nerve, generally due to increase in intra-ocular pressure.

There are 2 types of glaucoma:
  1. acute = closed angle glaucoma
  2. chronic = open angle glaucoma

Acute closed angle glaucoma

Acute closed angle glaucoma presents as:
  • pain
  • decreased visual acuity
  • worsening of pain with mydriasis
  • hard, red eye
  • halos around lights
  • semi-dilated, non-reactive pupil
  • pt systemically unwell

Risk factors for closed angle glaucoma include hypermetropia and pupillary dilation.

Management is:
  • urgent opthalmic review
  • IV acetazolamide (a carbonic anhydrase inhibitor; decreases aqueous secretions)
  • topical pilocarpine (constricts pupil)

Open angle glaucoma

This affects 2% of over 40s.

Risk factors include:
  • family history
  • black
  • myopia
  • hypertension
  • diabetes

Features include:
  • peripheral field loss
  • decreased visual acuity
  • optic disc cupping

Treatments include:
  • eye drops (beta blockers or prostaglandins)
  • possibly surgery.

Now to our final battle of the day, autonomic neuropathy