3 - Opth - Glaucoma - Acute angle closure glaucoma

Question 1

Pathophysiology 4 steps

Answer 1

lens pushed against iris, causing pupillary block

build up of aq in post chamber - bulging of iris - closure of irido corneal angle

blocks trab meshwork

overhydration of cornea - clouding - vesicles form on anterior cornea - v painful

Question 2

Risk factors

Answer 2

F:M 4:1
asians
shallow ant chamber
shorter axial length eg hypermetropia

Question 3

Secondary causes

Answer 3

inflamm - uveitis
neovascular - DM retinal vein occlusion
pigment dispersion syndrome (pig floats in aq and blocks trab meshwork)
traumatic hyphaema

Question 4

Presentation - Sx

Answer 4

pain (periocular/headache)
blurred vision, halos
N+V

Question 5

Presentation - Signs

Answer 5

brick red eye
cloudy cornea
fixed mid-dilated pupil
IOP >21
closed iridocorneal angle

Question 6

Management includes 3 things

Answer 6

topical , systemic and laser treatment (drops, systemic, medium term)

Question 7

What different eye drops are given and why? given STAT

Answer 7

BB and A agonist - to lower IOP
Once IOP <50 give MIOTIC - pilocarpine - to allow iris perfusion
Steroid for inflam

Question 8

What systemic treatments might be given

Answer 8

IV carb anhydrase inhibitors
IV hyperosmotic agent (mannitol) - reabsoprtion of fluid through increasing bl osmolality
Analgesia, anti-emetics

Question 9

What laser (medium term) treatments may be given

Answer 9

laser iridotomy - two small holes in iris - drainage - do non-attacked eye first then other eye within a week of attack

trabeculectomy - in resistant cases - hole in trab meshwork