24. Secondary Glaucoma
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Whats characteristic pigment deposition of PXF?
- ring like deposit on the ant lens capsule
- might not see it without dilation
- also on iris
Diff PXF and PDS iris transillumination?
- PXF: seen at pupillary border
- PDS: see more periphery
Race prevalence PXF?
- reduced dilation
- IOP spike
- weaker zonules: subluxation
PXF and glaucoma?
- PXF + glaucoma: yes once optic neuropathy occurs
- PXF w/o: yes 10-50% conversion
What type of glaucoma is assoc with PXF?
PXF management considerations?
- weakend zonules: cataract surgery
- IOP spikes
- no tx required if no POAG
What is PDS?
abnormal loss of pigment form post iris and redistributed across ant eye
What causes PDS?
rubbing of iris pigment epithelium on lens zonules
What predispositions of PDS?
- big ant chamb
- bowed iris and posterior
- young, myopic, white, males
What is krukenberg's spindle
abnormal golden pigment deposition on corneal endothelium seen in PDS
What is scheie stripe?
during full dilation you can see pigment deposition on the zonules near the post lens capsule
Pigment in the TM?
- PXF: segmental and patchy
- PDS: very dark, dense and diffuse
What are some assoc of PDS to other conditions?
lattice degneration and retinoschisis
how does PDS cause glaucoma?
- pigment accumulates in TM and impairs outflow
- IOP rises
- optic neuropathy
- conversion rate: 10-50% over 15 years
Management of PDS?
- no glaucoma, no tx
- monitor IOP spike post dilation
- document iris contours
Prophylatic PI for pds?
- releives pressure, bowing of iris, rubbing
- increases better circulation
DDx for PDS?
- trauma+ RD: unilateral
how does ant NV cause glaucoma?
- hypoxic signal sent from the post eye
- NV growth on iris and in AC angle
- obstructs angle
What conditions cause iris NV?
Management of NV glaucoma?
- otherwise extensive destructive surgery
inflammatory glaucoma- ACG?
pupil blocked: nv, synechiae, iris bombe,
inflammatory glaucoma- OAG?
inflammatory cells blocking TM or steroid use
- mild ant uv with HIGH IOP
steroid induced glaucoma?
spike rf: POAG, foh glaucoma, highy myopia, diabetes
What is angle recession?
- abnormal widening of CB band due to separation of muscle fibres caused by blunt trauma to the eye
- blunt trauma compresses globe and equatorial expansion occurs
how does angle recession cause glaucoma?
- disrumption of TM and laceration of CB: restriciton outflow
- can occur yearsss later
- cataract leaking proteins in AC
- macrophages plug TM
large lens blocks angle
ICE and glaucoma?
- proliferation of abnormal corneal endo cells migrating across angle and onto iris
- blockage of TM
episclearl venous pressure and glaucoma?
chronically raised episcleral venous pressure can make it more difficult for the aqueous to exit the eye
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