Acute Glaucoma

Question 1

What is acute glaucoma?

Answer 1

Aka angle-closure glaucoma/acute narrow-angle glaucoma

Sudden ↑ intraocular-pressure due to mechanical blockage of trabecular meshwork by iris

Often predisposing cataract and small eye (hypermetropia)

Ocular emergency

Question 2

What is normal intraocular pressure?

Answer 2

15-20 mmHg

Question 3

Who gets acute angle-closure glaucoma?

Answer 3

Middle-age/older patients

Higher in east asians

Question 4

What are the clinical features of acute glaucoma?

Answer 4

• severe eye pain
• watering
• loss of vision
• headache, nausea, vomiting
• halos around lights

O/E → hazy cornea + fixed mid-dilated pupil

Question 5

What is the treatment for acute glaucoma?

Answer 5

• systemic (PO or IV) acetazolomide → to turn off fluid production in ciliary body
• pilocarpine eye drops → pulls iris away from trabecular meshwork
• topical ocular antihypertensives + topical steroids

Definitive treatment is with bilateral YAG laser iridotomy (make hole in iris to allow fluid passage)

Question 6

Complications of acute glaucoma

Answer 6

Blindness can result if treatment delayed