Glaucoma Important Questions with Answers

Important Topics in Glaucoma

• Uveo-Scleral Outflow (10%)
• Normal-Tension Glaucoma (NTG)
• Tonometry
• Primary angle closure Glaucoma
• Plateau Iris
• PAC: Primary Angle Closure
• Resolved APAC: Vogts triad
• Pseudoexfoliation
• Pseudoexfoliation Syndrome (PEX)
• Lens Induced Glaucoma
• Neovascular Glaucoma
• Malignant Glaucoma
• Glaucoma Associated with Uveitis
• Steroid-Induced Glaucoma
• Traumatic Glaucoma
• ICE Syndrome (Irido-Corneo-Endothelial Syndrome)
• MIGS (Minimum incision glaucoma surgery)
• Glaucoma Surgery
• Trabeculectomy

Important Questions with Answers 

Q. What is Peripapillary Atrophy (PPA)

Ans. Peripapillary atrophy (PPA) is a clinical finding associated with chorioretinal thinning and

disruption of the retinal pigment epithelium (RPE) in the area surrounding the optic disc. β zone is an area of absolute scotoma. The α zone is due to chorioretinal atrophy (relative scotoma).

Q. The blood-aqueous barrier is formed by

Ans. 

• Non-pigmented epithelium (Tight junction)
• Vascular endothelium of iris. Aqueous flare in uveitis is due to break in the blood aqueous barrier because of increased capillary permeability in iris due to inflammation → leakage of larger molecules i.e., proteins.

Q. Facility of aqueous flow (ease of aqueous flow through outflow system) is measured by

Ans. Tonography. It is depicted by the C value, which is 0.22- 0.28 μl/min/mmHg.

Q. Most common complication of steroids in the eye is

Ans. Glaucoma.

Q. What is the Confrontation test?

Ans. Confrontation visual field testing involves having the patient look directly at the examiner's eye or nose and testing each quadrant in the patient's visual field by having them count the number of fingers that are shown.

Q. What is Lester Perimetry? 

Ans. The techniques that utilise the evaluation of RNFL to evaluate glaucoma.

Q. Which drug causes nasolacrimal duct obstruction?

Ans. Timolol

Q. Which anti-glaucoma drug causes drowsiness?

Ans. Brimonidine.

Q. Which drug is contraindicated in children as it can cause sleep apnea and can lead to heart blocks in children?

Ans. Brimonidine.

Q. Which drug can also be given during pregnancy?

Ans. Brimonidine.

Q. Which anti-glaucoma drug causes lid retraction?

Ans. Apraclonidine.

Q. What are the causes of conjunctival pigmentation/deposits?

Ans. Adrenaline.

Q. Which drug causes cystoid macular edema and is contraindicated in aphakic glaucoma?

Ans. adrenaline.

Q. Which anti-glaucoma drug causes heterochromia iridis? 

Ans. Latanoprost as it causes iris pigmentation.

Q. Which drug causes hypertrichosis?

Ans. PGF2ɑ agonists, especially bimatoprost.

Q. Which surgery can perform if the cornea is hazy or can't visualize?

Ans. Trabeculotomy, Trabeculectomy + Trabeculotomy (second choice of treatment).

Important One Liners to Remember in Glaucoma 

• The most common complication of steroids in the eye is glaucoma.
• Steroid induced glaucoma is primarily due to increased secretion of GAG.
• Antiglaucoma drug; Netarsudil- increases the contractile property of trabecular meshwork and increases the trabecular outflow.
• IOP is measured by tonometry.
• IOP measurement depends on Central Corneal Thickness (CCT).
• Peripapillary atrophy (PPA) is a clinical finding associated with chorioretinal thinning and disruption of the retinal pigment epithelium (RPE) in the area surrounding the optic disc.

• The temporal island of vision stays until the end.
• Bjerrum Area = Area in visual field where the first scotoma appearing corresponds to arcuate fibre.
• Treatment of choice PAC is pilocarpine.
• The drug of choice for PACG is Latanoprost.
• Pigmentary glaucoma also known as reverse glaucoma
• The first line of treatment is atropine. It dilates the ciliary ring and relaxes the ciliary muscles which causes stretching of zonules to pull back the lens, thus opening the block.
• The treatment of choice is anti-glaucoma drugs and once IOP is under control, steroids are given. Thus, steroids are given under anti-glaucoma cover.
• Buphthalmos is a condition in which a child's sclera is stretched to the extent that it enlarges the eyeball. As a result of the child's sclera being very soft, any pressure generated by the pressure inside the eyeball causes scleral stretching.

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