Acute Glaucoma

Question 1

Acute Glaucoma Definition

Answer 1

• Acutely raised intraocular pressure
• Physically obstructed anterior chamber angle
• Can be chronic

Question 2

Angle Closure Glaucoma Stages

Answer 2

• Latent (anatomical predispositions)
• Subacute (mild symptomatic epidisodes which spontaneously resolve)
• Acute
• Chronic
• Absolute (end stage of untreated disease, irreversibly sight impaired eye)

Question 3

Acute Glaucoma Epidemiology

Answer 3

• Most frequently occurs in 6th to 7th decade of life

- Females more likely to be affected than males

Question 4

Acute Glaucoma Presentation

Answer 4

• Pain, severe and rapidly progressive
• May be confined to eye but more usually spread around orbit with an associated frontal or generalised headache
• Blurred vision
• Coloured halos
• Systemic malaise
• Commonly caused by dilated pupil snagging, so attack comes on in moment of excitement or while watching TV in dim lighting
• Elderly people after GA
• Red eye with ciliary flush
• Redness around periphery of cornea

Question 5

Acute Glaucoma Primary vs Secondary

Answer 5

• Primary can be due to anatomy, some people have flatter eyes or narrower angles
• Eye often becomes more prone to glaucoma with age due to shape changes
• Secondary can occur from anterior causes e.g. synechiae or posterior causes e.g. lens bulging forward due to swelling
• Can also arise from blockage e.g. hyphaema, proteins

Question 6

Acute Glaucoma Diagnosis

Answer 6

At least two of

• Ocular pain
• N/V
• Hx of intermittent blurring of vision with haloes and three of
• IOP>21mmhg, conjunctival injection, corneal epithelial oedema, mild-dilated non-reactive pupil, shallow chamber in presence of occlusion

Question 7

Acute Glaucoma Differentials

Answer 7

-Other forms of glaucoma

Other causes of ocular pain

• Corneal disorder
• Anterior uveitis
• Scleritis
• Endophthalmitis
• Optic neuritis

Other causes of red eye

• Conjunctival causes
• Corneal causes
• Other causes

Question 8

Acute Glaucoma Management

Answer 8

• Immediate referral
• Topical glaucoma agents
• BBs, prostaglandin analogues (latanoprost), pilocarpine, phenylephrine (if they do not have their own lens)
• Acetazolamide IV
• If no response, systemic hyperosmotics e.g. mannitol
• If ineffective, paracentesis
• Once resolved, laser peripheral iridotomy