Acute closed angle glaucoma

Question 1

underlying pathology of acute closed angle glaucoma

Answer 1

iris bulges forward, seals off trabecular meshwork from anterior chamber –> aqueous humour stops draining –> pressure build up in ant & post chamber –> worsens iris closure

Question 2

why is acute closed angle glaucoma an ophthalmic emergency

Answer 2

can lead to blindness

Question 3

RFs acute closed angle glaucoma

Answer 3

• age
• females
• FH
• chinese/eastern european (rare in black)
• shallow ant chamber

Question 4

adrenergic, anticholinergic, tricyclic meds that can precipitate acute closed angle glaucoma

Answer 4

• noradrenaline
• oxybutynin, solifenacin
• amitriptyline

Question 5

classic presentation acute closed angle glaucoma

Answer 5

• painful red eye
• blurred vision
• halos around light (photophobia?)
• headache, nausea, vomiting

Question 6

signs & findings acute closed angle glaucoma

Answer 6

• hazy cornea
• fixed dilated pupil
• firm eyeball

Question 7

intervention whilst awaiting an ambulance

Answer 7

• lie on back w/out pillow
• pilocarpine drops
• acetazolamide
• analgesia & antiemetic

Question 8

2ry care interventions

Answer 8

• pilocarpine
• acetazolamide
• hyperosmotic agents
• timolol
• dorzolamide
• brimonidine

Question 9

Effects of pilocarpine as a muscarinic receptor on sphincter & ciliary muscles

Answer 9

Mitotic agent: contraction –> constrict iris

Question 10

give two examples of hyperosmotic agents and explain how they work

Answer 10

glycerol & mannitol

+ osmo grad between blood & eye fluid

Question 11

definitive tx

Answer 11

laser iridotomy