Acute angle closure glaucoma

Question 1

Acute angle closure glaucoma

Answer 1

• acute rise in intraocular pressure
• narrowing of the anterior chamber angle
• optic nerve damage and vision loss

Question 2

Acute glaucoma risk factors

Answer 2

• increasing age
• female sex
• east Asian ethnicity
• family history
• hypermetropia

Question 3

Acute glaucoma presentation

Answer 3

• unilateral severe eye pain/headache
• nausea and vomiting
• reduced visual acuity or visual loss
• haloes around bright lights
• hazy cornea
• fixed, mid-dilated, non-responsive pupil
• hard eye, IOP >30mmHg

Question 4

Acute glaucoma investigations

Answer 4

• gonioscopy to establish angle closure
• tonometry - Goldmann is gold standard but other methods e.g. portable tonometer

Question 5

Acute glaucoma management

Answer 5

• lay patient flat - gravity helps angle
• give oral analgesia, anti-emetics
• refer to ophthal:
• pressure-reducing - acetazolamide (systemic), beta-blockers (oral)
• topical steroids
• peripheral iridotomy for drainage
• may consider topical pilocarpine