ACUTE ANGLE-CLOSURE GLAUCOMA

Question 1

Clinical Features

Answer 1

Acute onset
Painfull eye
Blurred Vision / Halos
Corneal Injection
Firm globe
Hazy Cornea (Corneal edema)
Fixed Midpoint pupil
+/- afferent pupillary defect
Narrow anterior chamber
Elevated IOP

a/w
Frontal / Supraorbital Headache
N/V

Question 2

Risk Factors

Answer 2

Hypermetropia
Parasympatholytics (mydriatics, antihistamines)
Sympathomimetics (epinephrine, pseudoephdedrine)
Dim illumination

Question 3

Management

Answer 3

Timolol 0.5%
One drop

Apraclonidine 1%
One drop

Acetazolamide 500 mg IV

Mannitol 1-2 kg IV

Recheck IOP hourly

Topical pilocarpine 1-2%
One drop q 15 min x 2
Once IOP is below 40 mm Hg
THEN
4 times daily

Emergent Opthalmology Consult