Acute Angle Closure Glaucoma

Question 1

What is Acute angle closure (AAC) glaucoma

Answer 1

Acute closure of a per-existing narrow anterior chamber angle
*between iris and lateral cornea

Question 2

What is AAC precipitated by

Answer 2

Acute pupillary dilation
*forwards displacement of iris towards cornea

Question 3

What leads to obstruction of the aqueous humor

Answer 3

Anterior chamber angle narrows/closes
*leads to obstruction of the outflow of the aqueous humor

Question 4

What are the RF of ACC glaucoma

Answer 4

1. Age (40+)
2. Hyperopia (far-sighted)
3. FH
4. Asian
5. Non-ocular administration of anticholingeric

Question 5

What type of onset is ACC glaucoma

Answer 5

Rapid
*emergency

Question 6

What are the signs of ACC

Answer 6

Patient seeks treatment ASAP
1. Rapid onset of severe pain, blurred vision
2. Blurred vision, halos around lights
*precipitated by event that lead to acute pupillary dilation

Question 7

What would be found on PE

Answer 7

1. Red eye - circumcorneal conjunctival injection
2. Fixed, moderately dilated pupil
   *nonreactive pupillary response to light
3. Steamy cornea
4. Firm eyeball
5. IOP elected over 50 mm HG

Question 8

What needs to happen if someone presents with ACC

Answer 8

Emergent referral for ophthalmology consultation (ED)
1. Immediate control of IOP
2. Acetazolamide (IV, then PO)
2. Osmotic diuretics (IV, PO)

Question 9

What can be given once IOP decreases

Answer 9

Pilocarpine drops to reverse underlying angle closure
1. Cataract extraction is first lien

Question 10

What is the definitive treatment of ACC

Answer 10

Dependent on what lead to it in the first place
1. Laser peripheral iridotomy
2. Surgical peripheral iridectomy
3. Cataract extraction

Question 11

What is the prognosis of ACC

Answer 11

1. Severe and permanent blindness within 2-5 days after onset symptoms
   *tunnel vision will eventually lead to complete vision loss