Acute angle closure glaucoma

Question 1

What causes the raised intra-ocular pressure acute angle closure glaucoma?

Answer 1

Secondary to an impairment of aqueous outflow

Question 2

Please name 3 factors which predispose patients to acute angle closure glaucoma

Answer 2

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

Question 3

How would a patient with acute angle closure glaucoma present?

Answer 3

• severe pain (ocular/headache)
• decreased visual acuity
• hard, red-eye
• haloes around lights
• semi-dilated non-reacting pupil
• corneal oedema
• systemic upset (e.g. N+V)

Question 4

Investigations in AACG

Answer 4

Tonometry - for elevated IOP

Gonioscopy (a special lens for the slit lamp that allows visualisation of the angle)

Question 5

AACG should immediately be referred to an ophthalmologist. TRUE/FALSE?

Answer 5

TRUE

Question 6

Acute pharmacological management

Answer 6

PILOCARPINE (parasympathomimetic to increased outflow of the aqueous humour)

BETA BLOCKER (e.g. timolol to decreases aqueous humour production)

ALPHA-2-AGONIST (e.g. apraclonidine, dual mechanism)

IV acetazolamide

topical steroids to reduce inflammation

Question 7

Describe what definitive surgical management may be offered once AACG is stabilised

Answer 7

laser peripheral iridotomy

=> hole in the peripheral iris to aid aqueous humour flowing to the angle