24A. Closed angle glaucoma

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Author:
sookylala
ID:
241164
Filename:
24A. Closed angle glaucoma
Updated:
2013-11-12 04:59:00
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Closed angle glaucoma
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Description:
Closed angle glaucoma
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  1. What is angle closure glaucoma?
    • mecahnical obstruciton of TM: pupil block, anterior pulling/push
    • obstructs outflow
  2. 2 types of angle closure?
    • pupil block: aqueous flowing form post to ant chamb pushes on peripheral iris forward->blocks trab meshwork
    • peripheral anterior synechiae
  3. How can indentation gonio differentiate between pupil block and synechiae?
    • pupil block: indentation will relieve closure by pushing aqueous to the periphery and open the angle
    • synechiae: will see it, angle will not open
  4. Fellow eye with ACG?
    75% risk
  5. suspect?
    • no symptoms
    • 180-270 degree
  6. PAC?
    • PACS with ^IOP
    • no disc/VF changes
  7. PACG?
    optic neuropathy and VF loss
  8. sx of acute congestive closure?
    • redness
    • pain
    • blurry
    • haloes
    • tearing
    • photophobia
    • nausea.vomiting
    • HA
  9. Appearance of acute congestive closure?
    • unilateral
    • ciliary injection
    • corneal edema
    • dilate fixed vert elongated pupil
  10. Signs of acute congestive closure?
    • shallow AC
    • shaffer grade 0
    • IOP 50-80mmHg
  11. Management of acute attack
    • EMERGENCY: same day referral
    • lower IOP/break attack
    • VA loss 24-36 hrs
    • lie px supine
    • CAI inhibitor, miotics, steroids
    • corneal indentation (not synechiae
  12. Laser peripheral iridotomy
    • laser holes in the iris
    • prophylactic fellow eye
  13. cataract extraction
    • helps iris move backwards
    • reduces narrow angle
  14. Peripheral iridectomy?
    • remove a wedge of peripheral iris to increase outflow
    • ACG
  15. Chronic ACG
    • slow porgressive ACG
    • misdiagnosis: OAG
  16. Plateau iris syndrome?
    • thicking peripheral iris/anterior insertion of iris
    • dilate with caution
  17. ALT
    • laser is aimed at the junction of pig/non pic TM
    • burns are applied
    • if aimed too post/ant wont work and damage will occur
  18. SLT
    selectively targets pigmented cells with little or no damage to surrounding structres
  19. Level of effectiveness of laser trabeculoplasty?
    • 25-30% reduction in IOP
    • loses effect over ~5yrs
  20. ALT and SLT predictor success?
    • >65yo
    • TM pigmentation: PDS, PXF, POAG
  21. Trabeculectomy?
    • cut a flap in peripheral conjunctiva so aqueous can drain into sub tenon's space
    • filtration bleb
  22. drainage implant?
    • surgery to deal with refractory glaucoma
    • implants have long tube-> AC-> drain into episclearl plate-> acts as a bleb spreading device
  23. cyclodestructive procedures?
    • surgical and laser procedures that ablate the ciliary body to lower iop
    • lasr resort

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