Faculty Comments - Vision Change Case 3 - Answer 4:


Question 4: What type of glaucoma is she most likely to have? What about her history and physical is consistent or inconsistent with this diagnosis?

Answer:

There are two major types of glaucoma: Primary Open Angle Glaucoma and Acute Closed Angle Glaucoma. Their similarities/differences are noted in the table below:
  Acute Closed Angle Primary Open Angle
Onset Quick Gradual
Prevalence of Type More common than acute closed angle
Mechanism/Etiology Trabeculum becomes suddenly occluded, causing an abrupt rise in IOP. Less severe occlusion
Symptoms (Sx) Pain, nausea, colored halos/rainbows around light. Pt classically describe “halos” around lights and pain, but most are asymptomatic
Signs Red, teary eye with a hazy cornea and a fixed, mid-dilated pupil.  Eye feels extremely firm to palpation.  Also may see a shallow anterior chamber.  Late finding: Loss of areas of sight during visual field testing.
Retinal optic cup enlargement.
Treatment (Tx) Primarily Surgical
Ophthalmologic Emergency		 Primarily Medication


Her story is more consistent with Primary Open Angle Glaucoma because of
 Return to Vision Change Case 3, Question 4  



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