Acute Angle-Closure Glaucoma

Question 1

List three factors predisposing to acute angle-closure glaucoma.

Answer 1

• Hypermetropia (long-sightedness)
• Pupillary dilatation
• Lens growth associated with age

Question 2

What are the severe pain symptoms associated with AACG?

Answer 2

May be ocular or headache.

Question 3

What happens to visual acuity in acute angle-closure glaucoma?

Answer 3

Decreased visual acuity.

Question 4

How do symptoms of AACG worsen?

Answer 4

Symptoms worsen with mydriasis (e.g. watching TV in a dark room).

Question 5

What is a common physical sign of AACG?

Answer 5

Hard, red-eye.

Question 6

What visual phenomenon may patients with AACG experience?

Answer 6

Halos around lights.

Question 7

What is the state of the pupil in acute angle-closure glaucoma?

Answer 7

Semi-dilated non-reacting pupil.

Question 8

What effect does corneal oedema have on the cornea in AACG?

Answer 8

Results in dull or hazy cornea.

Question 9

What systemic symptoms may be seen in AACG?

Answer 9

• Nausea
• Vomiting
• Abdominal pain

Question 10

Cause of acute angle-closure glaucoma?

Answer 10

Rise in IOP secondary to impairment of aqueous outflow.

Question 11

What is the purpose of tonometry in investigations?

Answer 11

To assess for elevated intraocular pressure (IOP)

Tonometry is a diagnostic test used to measure the pressure inside the eye.

Question 12

What is gonioscopy?

Answer 12

A special lens for the slit lamp that allows visualization of the angle

The term ‘gonioscopy’ literally means looking at the angle.

Question 13

What is the management approach for acute angle-closure glaucoma (AACG)?

Answer 13

It is an emergency that requires urgent referral to an ophthalmologist

Emergency medical treatment is essential to lower the IOP.

Question 14

What is the goal of emergency medical treatment for AACG?

Answer 14

To lower the intraocular pressure (IOP)

Definitive surgical treatment is provided once the acute attack has settled.

Question 15

What is an example of a direct parasympathomimetic used in AACG treatment?

Answer 15

Pilocarpine

Pilocarpine causes contraction of the ciliary muscle, opening the trabecular meshwork and increasing outflow of aqueous humour.

Question 16

What is the role of beta-blockers in AACG management?

Answer 16

To decrease aqueous humour production

An example is timolol.

Question 17

What are the dual mechanisms of the alpha-2 agonist apraclonidine?

Answer 17

Decreasing aqueous humour production and increasing uveoscleral outflow

Apraclonidine is used in the management of elevated IOP.

Question 18

What is the function of intravenous acetazolamide in AACG treatment?

Answer 18

Reduces aqueous secretions

It is an important part of the emergency treatment regimen.

Question 19

What additional treatment may be recommended to reduce inflammation in AACG?

Answer 19

Topical steroids

Some guidelines suggest the use of topical steroids as part of the treatment.

Question 20

What is the definitive management technique for AACG?

Answer 20

Laser peripheral iridotomy

This procedure creates a tiny hole in the peripheral iris to allow aqueous humour to flow to the angle.

Question 21

Fill in the blank: A direct parasympathomimetic causes contraction of the ciliary muscle, leading to _______.

Answer 21

opening the trabecular meshwork

This increases the outflow of aqueous humour.