Acute Angle Closure Glaucoma

Question 1

What is glaucoma ?

Answer 1

Optic neuropathy due to in majority of patients raised intraocular pressure

Question 2

X

Answer 2

X

Question 3

X

Answer 3

X

Question 4

X

Answer 4

X

Question 5

C

Answer 5

C

Question 6

C

Answer 6

C

Question 7

C

Answer 7

C

Question 8

C

Answer 8

C

Question 9

C

Answer 9

C

Question 10

What causes acute angle-closure glaucoma (AACG)?

Answer 10

acute angle-closure glaucoma (AACG) there is a rise in IOP secondary to an impairment of aqueous outflow

Question 11

Factors predisposing to AACG include:

Answer 11

hypermetropia (long-sightedness)
pupillary dilatation
lens growth associated with age

Drugs which may precipitate acute glaucoma include
anticholinergics - atropine etc
tricyclic antidepressants - Amitryptiline (also used for migraine prophylaxis, tension type headache prophylaxis)

Question 12

X

Answer 12

X

Question 13

What are the symptoms of AACG?

Answer 13

Severe pain maybe ocular or headache

Visual acuity decreases

Hard and red eyes

Symptoms worsens with mydriasis - in a dark room watching TV

Halos around light

Semi dilated non reacting pupil

corneal oedema results in dull or hazy cornea

systemic upset may be seen, such as nausea and vomiting and even abdominal pain

Question 14

What is the management for AACG?

Answer 14

urgent referral to an ophthalmologist

COMBINATION of eye drops, for example:

a direct parasympathomimetic
(e.g. pilocarpine

a beta-blocker - timolol (decreases aqueous humour production)

an alpha-2 agonist (e.g. apraclonidine / brimonidine
(dual mechanism, decreasing aqueous humour production and increasing uveoscleral outflow)

========

intravenous acetazolamide
(reduces aqueous secretions)

Question 15

Function of pilocarpine (parasympathomemtic) ?

Answer 15

causes contraction of the ciliary muscle → opening the trabecular meshwork → increased outflow of the aqueous humour)

Question 16

Function of a beta-blocker (e.g. timolol,

Answer 16

decreases aqueous humour production)

Question 17

function of an alpha-2 agonist (e.g. apraclonidine/ brimonidine)

Answer 17

dual mechanism, decreasing aqueous humour production and increasing uveoscleral outflow

Question 18

function of acetazolamide/ brinzolamide carbonic anhydrase inhibitors

Answer 18

reduces aqueous secretions

Question 19

Definitive management of acute angle closure glaucoma ?

Answer 19

laser peripheral iridotomy
creates a tiny hole in the peripheral iris → aqueous humour flowing to the angle

Question 20

side effects of Miotics (e.g. pilocarpine, a muscarinic receptor agonist)?

Answer 20

constricted pupil, headache and blurred vision