Glaucoma

Topics in this chapter

• Glaucoma Pathophysiology and Classification
• Open-Angle Glaucoma and Ocular Hypertension
• Angle-Closure Glaucoma
• Secondary and Neovascular Glaucoma
• Glaucoma Diagnosis and Visual Fields
• Glaucoma Medications and Adverse Effects
• Glaucoma Laser and Surgical Treatment

Practice questions

1. Question 1Q-5C740F

   A 65-year-old man presents with sudden onset severe eye pain, headache, nausea, and vomiting in his right eye. On examination, the visual acuity is counting fingers, the right pupil is mid-dilated and non-reactive, and the cornea is hazy with epithelial edema. Intraocular pressure (IOP) is 58 mmHg. Gonioscopy of the left eye reveals a narrow angle with a convex iris plane. What is the most appropriate immediate medical therapy to lower the intraocular pressure before definitive surgical intervention?

   1. A.Intravenous Mannitol and topical Pilocarpine
   2. B.Topical Atropine and intravenous Acetazolamide
   3. C.Topical Timolol and latanoprost
   4. D.Intravenous steroids and topical Phenylephrine
   See the answer and solution
2. Question 2Q-46C9D6

   A 45-year-old chronic smoker presents for a routine eye check-up. His visual acuity is 20/20 in both eyes. Intraocular pressure is 24 mmHg in the right eye and 22 mmHg in the left eye. Gonioscopy shows open angles (Shaffer grade 4) in all quadrants. Automated perimetry reveals normal visual fields, and the optic nerve head shows a cup-to-disc ratio of 0.3 with healthy neuroretinal rims. What is the most appropriate management at this stage?

   1. A.Initiate lifelong topical prostaglandin analogues immediately
   2. B.Perform immediate Laser Peripheral iridotomy (LPI)
   3. C.Observe and monitor with serial IOP checks, gonioscopy, and visual fields
   4. D.Perform trabeculectomy with mitomycin C
   See the answer and solution
3. Question 3Q-9974E6

   A 70-year-old man with primary open-angle glaucoma is started on a topical eye drop to lower his intraocular pressure. At his follow-up visit, he complains of darkening of the iris color, lengthening and thickening of his eyelashes, and hyperpigmentation of the periocular skin. Which medication was most likely prescribed?

   1. A.Timolol
   2. B.Brimonidine
   3. C.Latanoprost
   4. D.Dorzolamide
   See the answer and solution
4. Question 4Q-AA803F

   A 55-year-old male is evaluated for chronic open-angle glaucoma. Slit-lamp examination reveals fine, white, flaky dandruff-like material deposited on the pupillary margin, anterior lens capsule, and trabecular meshwork. A transillumination defect of the iris pupillary ruff is also noted. What is the diagnosis?

   1. A.Pseudoexfoliation syndrome
   2. B.Pigment dispersion syndrome
   3. C.Fuchs heterochromic iridocyclitis
   4. D.Primary angle-closure glaucoma
   See the answer and solution
5. Question 5Q-99E9B3

   In the management of glaucoma, which laser procedure creates a full-thickness hole in the peripheral iris to allow aqueous humor to flow directly from the posterior chamber to the anterior chamber, relieving pupillary block?

   1. A.Selective Laser Trabeculoplasty (SLT)
   2. B.Laser Peripheral Iridotomy (LPI)
   3. C.Cyclophotocoagulation (CPC)
   4. D.Argon Laser Trabeculoplasty (ALT)
   See the answer and solution