Acute angle closure glaucoma Flashcards
What is glaucoma?
Glaucoma is a group of disorders characterised by optic neuropathy, primarily due to raised intraocular pressure (IOP). It is recognised that some patients with raised IOP do not have glaucoma and vice versa.
What causes acute angle-closure glaucoma (AACG)?
AACG is caused by a rise in IOP secondary to an impairment of aqueous outflow.
What are the predisposing factors for AACG?
Predisposing factors include hypermetropia (long-sightedness), pupillary dilatation, and lens growth associated with age.
What are the features of AACG?
Features include severe pain (ocular or headache), decreased visual acuity, symptoms worsening with mydriasis, hard red-eye, haloes around lights, semi-dilated non-reacting pupil, corneal oedema, and systemic upset (nausea, vomiting, abdominal pain).
What investigations are used for AACG?
Investigations include tonometry to assess for elevated IOP and gonioscopy to visualize the angle.
What is the management approach for AACG?
AACG management is an emergency requiring urgent referral to an ophthalmologist and emergency medical treatment to lower IOP.
What is an example regime for initial medical treatment of AACG?
An example regime includes a combination of eye drops such as a direct parasympathomimetic (e.g. pilocarpine), a beta-blocker (e.g. timolol), an alpha-2 agonist (e.g. apraclonidine), and intravenous acetazolamide.
What is the definitive management for AACG?
Definitive management involves laser peripheral iridotomy, which creates a tiny hole in the peripheral iris to allow aqueous humour to flow to the angle.
