Acute Angle-Closure Glaucoma Flashcards
List three factors predisposing to acute angle-closure glaucoma.
- Hypermetropia (long-sightedness)
- Pupillary dilatation
- Lens growth associated with age
What are the severe pain symptoms associated with AACG?
May be ocular or headache.
What happens to visual acuity in acute angle-closure glaucoma?
Decreased visual acuity.
How do symptoms of AACG worsen?
Symptoms worsen with mydriasis (e.g. watching TV in a dark room).
What is a common physical sign of AACG?
Hard, red-eye.
What visual phenomenon may patients with AACG experience?
Halos around lights.
What is the state of the pupil in acute angle-closure glaucoma?
Semi-dilated non-reacting pupil.
What effect does corneal oedema have on the cornea in AACG?
Results in dull or hazy cornea.
What systemic symptoms may be seen in AACG?
- Nausea
- Vomiting
- Abdominal pain
Cause of acute angle-closure glaucoma?
Rise in IOP secondary to impairment of aqueous outflow.
What is the purpose of tonometry in investigations?
To assess for elevated intraocular pressure (IOP)
Tonometry is a diagnostic test used to measure the pressure inside the eye.
What is gonioscopy?
A special lens for the slit lamp that allows visualization of the angle
The term ‘gonioscopy’ literally means looking at the angle.
What is the management approach for acute angle-closure glaucoma (AACG)?
It is an emergency that requires urgent referral to an ophthalmologist
Emergency medical treatment is essential to lower the IOP.
What is the goal of emergency medical treatment for AACG?
To lower the intraocular pressure (IOP)
Definitive surgical treatment is provided once the acute attack has settled.
What is an example of a direct parasympathomimetic used in AACG treatment?
Pilocarpine
Pilocarpine causes contraction of the ciliary muscle, opening the trabecular meshwork and increasing outflow of aqueous humour.
What is the role of beta-blockers in AACG management?
To decrease aqueous humour production
An example is timolol.
What are the dual mechanisms of the alpha-2 agonist apraclonidine?
Decreasing aqueous humour production and increasing uveoscleral outflow
Apraclonidine is used in the management of elevated IOP.
What is the function of intravenous acetazolamide in AACG treatment?
Reduces aqueous secretions
It is an important part of the emergency treatment regimen.
What additional treatment may be recommended to reduce inflammation in AACG?
Topical steroids
Some guidelines suggest the use of topical steroids as part of the treatment.
What is the definitive management technique for AACG?
Laser peripheral iridotomy
This procedure creates a tiny hole in the peripheral iris to allow aqueous humour to flow to the angle.
Fill in the blank: A direct parasympathomimetic causes contraction of the ciliary muscle, leading to _______.
opening the trabecular meshwork
This increases the outflow of aqueous humour.
