LECTURE 5: HISTORY, PHYSICAL AND TREATMENT OF GLAUCOMA AND CATARACTS
Identify the risk factors for development of open/closed angle glaucoma.
Closed- Risk factors- over 40, family history, steroid use (PREDNISONE), AA, winter time, HTN, obesity, lack of exercise, IOP peaks in AM
Open- Risk Factors- shallow anterior portion, older people with cataracts, hyperopia/myopia, AA, inheritance
Understand the differences in history, presentation, pathophysiology, and treatments for closed angle glaucoma
1. H&P- sudden onset of eye pain, decreased vision, halos around lights, headache, nausea/vomiting
2. PE- corneal edema, mid-dilated and non-reactive pupil, ciliary injection, shallow anterior chamber, complete angle closure on gonoiscopy
3. Management- meds with compliance (beta blockers, alpha 2 agonists, miotics, carbonic anhydrase inhibitors, prostaglandin analogues to reduce aqueous production or to improve aqueous outflow), laser trabeculoplasy (hole to let fluid out), surgery (drainage device placement)
Understand the differences in history, presentation, pathophysiology, and treatments for open angle glaucoma
1. H&P-Most common type of glaucoma. Optic nerve atrophy (cupping) AND visual field loss resulting from IOP that is too high for a particular nerve. Predisposing family history, steroid use, surgeries, race, hypertension, myopia.
2. PE- Onset usually insidious and asymptomatic w/visual field loss not noticed until late in the disease. Prevalence in AA and over 65 YOA. IOP MAY be > 21.
3. Management- Surgery (trabeculectomy). Beta blockers (Timolol), Alpha 2 Agonists (Alphagan), and Miotics.
Discuss screening/diagnostic tests for glaucoma.
-check IOP with tonometer/tonopen
-ophthalmoscopy- look for disc damage and optic nerve evaluation
-check for visual field loss
-test- nerve fiber layer analysis
Identify predisposing factors for the development of cataracts.
Risk factors- include age, smoking, EtOH, Diabetes Mellitus, systemic corticosteroid use (WILL get cataract if use prednisone). Atopic Dermatitis, trauma (concussion, penetration, ionizing radiation, shock, lightning). Neonates- intrauterine infections or metabolic disorders
Know the history, presentation, exam findings, special test, and treatments for cataracts.
1. H&P- Protein of the lens discolors and clouds the lens with age. Can be congenital. Several different types including from trauma.
2. PE- Pt. typically complains of slowly progressive, painless visual impairment. Seen on exam as opacity behind pupil and possibly lost red retinal reflex.
3. Management- Surgical lens replacement.