Acute angle-closure glaucoma (Complete)

Question 1

What is glaucoma?

Answer 1

Group of disorders characterised by optic neuropathy due, in the majority of patients, to raised intraocular pressure (IOP)

Question 2

What is acute angle-closure glaucoma

Answer 2

Rise in IOP secondary to an impairment of aqueous outflow.

Question 3

What are factors which increase risk of AACG?

Answer 3

Hypermetropia (long-sightedness)

Pupil dilation (e.g. tropacamide use at opticians)

Lens growth (assosciated with age)

Question 4

Long-sightedness is also known as?

Answer 4

Hypermetropia

Question 5

What are the features of AACG?

Answer 5

Severe pain: occulor or headache

Decreased visual acuity (Blurred vision)

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

Hard red-eye

Haloes around bright lights

Semi-dilated non reactive pupil

Hazy cornea (due to corneal oedema)

Systemic upset: Nausea, abdominal pain, vomitting

Question 6

What visual disturbances are present in AACG?

Answer 6

Visual halo around lights

Blurred vision (reduced visual acuity)

Question 7

What are complications of AACG?

Answer 7

Permament blindness

Permament eye dilation

Iris sphincter atriphy (decereased pupil reflex)

Question 8

What are main investigations for AACG?

Answer 8

Tonometry: assess for elevated IOP

Gonioscopy: A special lens for the slit lamp that allows visualisation of the angle

Question 9

How is AACG managed?

Answer 9

Urgent opthalmoscopy referal

Medicine: Combination of eyedrops such as:

Anti-muscarinics: E.g. pilocarpine

Beta-blocker: Timolol

Alpha-2-agonist: e.g. Apraclonidine

Surgical: Definitive management:

Laser peripheral iridotomy