Acute glaucoma

Question 1

Features of acute closed-angle glaucoma

Answer 1

symptoms worse with mydriasis (e.g. watching TV in a dark room)
hard, red-eye
haloes around lights
semi-dilated non-reacting pupil

Question 2

Investigations

Answer 2

tonometry to assess for elevated IOP
gonioscopy (literally looking, oscopy, at the angle, gonio): a special lens for the slit lamp that allows visualisation of the angle

Question 3

Management

Answer 3

urgent referral to ophtalmology

a direct parasympathomimetic (e.g. pilocarpine
a beta-blocker (e.g. timolol,
an alpha-2 agonist (e.g. apraclonidine

IV acetazolamide

Question 4

direct parasympathomimetic causes contraction of the ciliary muscle → opening the trabecular meshwork → increased outflow of the aqueous humour

Answer 4

pilocarpine

Question 5

decreases aqueous humour production

Answer 5

beta-blocker e.g. timolol

Question 6

dual mechanism, decreasing aqueous humour production and increasing uveoscleral outflow

Answer 6

apraclonidine, an alpha-2 agonist

Question 7

reduces aqueous secretions

Answer 7

IV acetazolamide

Question 8

Definitive management

Answer 8

laser peripheral iridotomy