Acute Angle-Closure Glaucoma Flashcards
what is glaucoma?
group of disorders characterised by optic neuropathy due to raised intraocular pressure (IOP)
what is the pathophysiology of acute angle-closure glaucoma?
rise in intraocular pressure secondary to an impairment of aqueous outflow
what factors predispose to acute angle-closure glaucoma?
- hypermetropia (long-sightedness)
- pupillary dilatation
- lens growth associated with age
what are the features of acute angle-closure glaucoma?
- severe pain
- decreased visual acuity
- symptoms worse with mydriasis
- hard, red-eye
- haloes around lights
- systemic upset - nausea, vomiting, abdominal pain
what will be seen on examination in acute angle-closure glaucoma?
- hard, red-eye
- semi-dilated non-reacting pupils
- corneal oedema –> dull or hazy cornea
what investigations should be performed in acute angle-closure glaucoma?
- tonometry = assess for elevated IOP
- gonioscopy
what is gonioscopy?
special lens for the slit lamp that allows visualisation of the angle
what is the managment of acute angle-closure glaucoma?
emergency
URGENT REFERRAL TO AN OPHTHALMOLOGIST
what is the initial medical treatment of acute angle-closure glaucoma?
- eye drops to lower IOP (e.g. pilocarpine, timolol or apraclonidine)
- IV acetazolamide
what does acetazolamide do?
reduces aqueous secretions
what is the definitive management of acute angle-closure glaucoma
laser peripheral iridotomy
what is laser peripheral iridotomy?
creates a tiny hole in the peripheral iris –> aqueous humour flowing to the angle
