Acute Glaucoma

Question 1

What is acute angle closure glaucoma?

Answer 1

an acute rise in intraocular pressure associated with the narrowing of the anterior chamber angle of the eye

Question 2

What structure supplies nutrients to the cornea and lens?

Answer 2

Aqueous humour

Question 3

What is the anterior chamber of the eye?

Answer 3

The area between the iris and cornea

Question 4

Where does the aqueous chamber originate and pass through?

Answer 4

1. Produced by the ciliary body
2. Travels through the pupil into the anterior chamber

Question 5

How does the aqueous humour drain?

Answer 5

drains out of the anterior chamber through the trabecular meshwork and flows into the canal of Schlemm

Question 6

What is the normal intraocular pressure?

Answer 6

11-21 mmHg

Question 7

Describe the pathophysiology of acute angle closure glaucoma:

Answer 7

1. Pupillary block occurs between the iris and the lens
2. The iris is in a mid-dilated position, narrowing the anterior chamber angle
3. This causes a rapid rise in aqueous humour and so a rise intraocular pressure

Question 8

Give 6 risk factors of glaucoma:

Answer 8

1. Increasing age
2. Female sex
3. Hypermetropia
4. Family history
5. East Asian ethnicity
6. Short eyeball length

Question 9

What is hypermetropia?

Answer 9

long-sightedness

Question 10

Give two classes of drugs that cause pupil mid dilation (and so increase risk of acute angle closure glaucoma):

Answer 10

1. Antidepressants (SSRIs and TCAs)
2. Anticholinergics (oxybutylin)

Also pupil-dilating drops and dark rooms

Question 11

Give 7 clinical presentations associated with acute angle closure glaucoma:

Answer 11

1. Unilateral severe eye pain
2. Headache that may cause nausea and vomiting
3. Profound reduction in visual acuity or vision loss
4. Rainbow-coloured halos around bright lights
5. Red, hard eye
6. hazy appearance of the cornea (due to corneal oedema)
7. Fixed pupil (non-reactive)

Question 12

Describe a method for confirming high intraocular pressure during examination:

Answer 12

ask the patient to close their eye and gently palpate using the tips of both index fingers - an eye with a very high intraocular pressure will feel hard on palpation

Question 13

Give two investigations used to assess acute angle closure glaucoma:

Answer 13

1) gonioscopy
2) tonometry

Question 14

What is the gold standard investigation for assessing the angle between the iris and cornea?

Answer 14

gonioscopy

Question 15

What is tonometry used for?

Answer 15

is used to measure intraocular pressure

Question 16

What intraocular pressure indicates acute angle closure glaucoma?

Answer 16

> 30 mmHg

Question 17

What equipment is used during tonometry?

Answer 17

Goldmann applanation tonometry

Question 18

How does Goldmann applanation tonometry measure intraocular pressure?

Answer 18

it assesses the force required to flatten a fixed area of the cornea

Question 19

True or false: AACG is a sight-threatening ophthalmic emergency

Answer 19

true

Question 20

Give 3 conservative methods used to manage acute angle closure glaucoma:

Answer 20

1 Analgesics
2. anti-emetics
3. Lying flat on back (gravity helps to open the anterior chamber angle)

Question 21

Name a systemic pressure reducing agent used in the treatment of AACG:

Answer 21

acetazolamide

Question 22

Name a total pressure reducing agent class used in the treatment of AACG:

Answer 22

beta blockers

Question 23

What is the name of the procedure that creates a hole in the iris to allow a separate route for aqueous drainage using lasers in AACG management?

Answer 23

peripheral iridotomy

Question 24

What is peripheral iridotomy?

Answer 24

(a laser hole through the iris) to allow a separate route for aqueous drainage other than through the pupil

Question 25

Give 5 specialist management strategies used for AACG:

Answer 25

1) systemic pressure reducing agents
2) topical pressure reducing agents
3) topical steroids (for inflammation)
4) peripheral iridotomy
5) total pilocarpine

Question 26

Name 3 complications of acute angle closure glaucoma?

Answer 26

1. Sight loss
2. Central or branch retinal vein occlusion
3. Repeated episodes of AAGG