LECTURE 5: HISTORY, PHYSICAL AND TREATMENT OF GLAUCOMA AND CATARACTS

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LECTURE 5: HISTORY, PHYSICAL AND TREATMENT OF GLAUCOMA AND CATARACTS
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Graduate school, Professional
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1

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

2

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)

3

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.

4

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

5

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

6

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.