Acute Glaucoma (Closed-Angle Glaucoma)

Question 1

Risk Factors of Angle-Closure Glaucoma (Acute Glaucoma) (9).

Answer 1

1. Increasing Age.
2. Females (4:1).
3. Family History.
4. Chinese and East Asian Ethnicity.
5. Shallow Anterior Chamber.
6. Medications - Adrenergic (e.g. Noradrenaline); Anticholinergic (e.g. Oxybutynin, Solifenacin); TCA (Amitriptyline).
7. Hypermetropia (Long-Sightedness).
8. Pupillary Dilation.
9. Lens Growth (Associated with Age).

Question 2

Pathophysiology of Angle-Closure Glaucoma (Acute Glaucoma) (3).

Answer 2

1. The iris bulges forward and seals off the trabecular meshwork from the anterior chamber.
2. This will prevent the drainage of aqueous humour, leading to a continous build-up of pressure.
3. The pressure particularly builds up in the posterior chamber which causes pressure behind the iris and worsens the closure of the angle.

Question 3

Optic Cupping Aetiology (3).

Answer 3

1. Optic Cup is found in the centre of the Optic Disc - a small indent that is usually less than half the size of the disc.
2. If IOP is raised, the cup enlarges (cupping).
3. Abnormal - Optic Cup is greater than 1/2 the size of Optic Disc.

Question 4

Clinical Features of Angle-Closure Glaucoma (Acute Glaucoma) (5).

Answer 4

1. Severely Painful Red Eye.
2. Blurred Vision.
3. Halos around Lights.
4. Associated Headaches, Nausea and Vomiting.
5. Symptoms are worse with mydriasis e.g. watching TV in a dark room.

Question 5

Eye Examination Findings of Angle-Closure Glaucoma (Acute Glaucoma) (5).

Answer 5

1. Appearance : Red-Eye, Teary, Hazy Cornea (corneal oedema).
2. Decreased Visual Acuity.
3. Dilation of Affected Pupil (sem-dilated).
4. Fixed Pupil Size (non-reacting).
5. Firm Eyeball on Palpation.

Question 6

Immediate Management of Angle-Closure Glaucoma (Acute Glaucoma) (2D).

Answer 6

1. Patients with potentially life-threatening causes of red eye should be referred for same day assessment by an ophthalmologist.
2. If there is a delay in admission whilst waiting for an ambulance :
   2A. Lie patient on back without pillow.
   2B. Administer Pilocarpine Eye Drops.
   2C. Administer Acetazolamide 500mg orally or IV.
   2D. Administer Analgesia/Antiemetics as required.

Question 7

Secondary Care Management of Angle-Closure Glaucoma (Acute Glaucoma) (4).

Answer 7

1. Triad Eye Drops - PAT (Pilocarpine, Acetazolamide, Timolol).
2. Hyperosmotic Agents.
3. Sympathomimetic Agents.
4. Laser Peripheral Iridotomy.

Question 8

Indication of Laser Peripheral Iridotomy.

Answer 8

Definitive treatment of angle-closure glaucoma (acute glaucoma).

Question 9

Laser Peripheral Iridotomy (3).

Answer 9

1. Laser is used to make a hole in the iris.
2. Aqueous humour can now flow from the posterior chamber into the anterior chamber.
3. Relieves pressure that was pushing the iris against the cornea.

Question 10

Prognosis of Angle-Closure Glaucoma (Acute Glaucoma).

Answer 10

It is an ophthalmological emergency - treatment is required ASAP to prevent a permanent loss of vision.