Acute Angle Closure Glaucoma Flashcards
When does Acute Angle closure glaucoma occur?
When the iris bulges forward and seals off the trabecular meshwork from the anterior chamber, preventing AH being able to drain away. This causes a pressure build up in the eye
What is acute angle closure glaucoma?
MEDICAL EMERGENCY
-Optic nerve damage caused by a rise in intraocular pressure
-Acute rise in intra-ocular pressure due to closure of angle between the iris and cornea
Risk factors for AACG?
Increasing age
Females > males
Family history
Chinese/east Asian (rare in black people)
What medications can precipitate AACG?
Adrenergic meds (noradrenalin) Anticholinergic meds (Oxybutynin/solifenacin) Tricyclic Antidepressants (amitryptyline) Nebulised ipratropium,
Presentation of AACG?
Severely painful unilateral red eye Blurred vision Halos around lights Associated headache, Nausea/vomiting -Clouding of cornea -Pupil fixed and mildly dilated -No pupillary light response -Eyes stony and hard
Examination of AACG shows?
Red eye Decreased visual acuity Teary Hazy cornea Fixed pupil size Dilation of pupil affected Firm eyeball on palpation
Initial management of AACG?
Refer for day assessment by ophthalmologist
Managing AACG while waiting for an ambulance?
Lie patient back
Give topical pilocarpine eye drops
Give acetazolamide 500mg oral
Give analgesia and anti-emetic
Side effects and indications for pilocarpine eye drops?
Blue eyes= 2%
Brown eyes= 4%
Side effects: pupil constriction, ciliary muscle contraction
Secondary care management?
Things to reduce pressure
- Pilocarpine
- Acetazolamide (IV/oral)
- Hypercosmotic agents (glycerol or mannitol)
- Timolol
- Dorzolamide
- Brimonidine
Last resort for AACG?
Laser iridotomy
- Laser makes hole in iris to allow AH to flow from posterior chamber to anterior chamber
