Acute red eye + AACG Flashcards
list the causes of an acute red eye (6)
- Scleritis
- Episcleritis
- Anterior uveitis
- Infectious keratitis
- Conjunctivitis
- Acute angle closure glaucoma
what is the importance in asking about sexual history?
Chlamydia can be spread to the eye causing conjunctivitis
what is the importance of asking about a recent URTI?
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conditions that present with both red eye + photophobia
- Scleritis
- Anterior uveitis
- Infectious keratitis
pathophysiology of AACG
blockage of flow of aqueous humour from the posterior to anterior chamber resulting in a build up of pressure behind the irs, produces a hard eye
risk factors for AACG? (4)
- hypermetropia
- pupillary dilatation
- lens growth associated with ageing
- female
appearance of eye and cause of this in AACG
- red: inflammation
- painful: raised IOP
associated symptoms in AACG?
- progressive headache, and may give a history of intermittent headaches that usually are in the evening
visual changes in AACG
blurry vision
visual symptoms and the cause of this in AACG?
- visual halos around lights/ “looking at a light through frosted glass”
- due to dispersion of light through waterlogged cornea
examination signs in AACG?
- hazy cornea
- fix and mid dilated pupil
- red + tender eye
- pupil non reactive to light
- impaired visual acuity
- eye is hard on gentle palpation
1st line investigations in AACG?
gonioscopy + slit lamp examination
finding on Gonioscopy?
closed angle
finding on slit lamp examination?
shallow anterior chamber + large optic disc
Management of AACG?
- urgent referral to ophthalmology
- IOP reduction with Acetozolamide 500 mg oral
- topical pilocarpine: to induce pupil constriction
- steroid eye drops
what is the definitive management of AACG?
laser iridotomy
what is laser iridotomy?
creating a hole in the iris, allowing aqueous humor to flow into the anterior chamber; reducing the pressure difference between the anterior and posterior chambers, allowing the angle to open up and decrease the IOP
medications that lower the intraocular pressure by reducing the production of aqueous humor?
Beta adrenergic receptor antagonists
Acetozolamide (CAI)
medications that increase the outflow of aqueous humor?
Iatanoprost (prostaglandin analogue)
medication that both decreases the production and increases the outflow
Bimonidine (alpha adrenergic agonist)
when must patients with AACG inform the DVLA about their diagnosis?
as soon as they are diagnosed with AACG they must stop driving and inform the DVLA whom will then assess whether the individual meets the current driving standards
equiptment that measures intraocular pressure
Goldmann visual field machine
what are the 3 stages for the drainage of fluid out of the eye/
1) flows forwards over the anterior surface
2) through the pupil
3) through the trabecular meshwork into schlemms canal
4 risk factors for ACAG
- elderly
- chinese race
- cataracts
- hypermetropia
immediate treatment for ACAG?
IV acetozolamide
what is the action of acetozolamide?
suppresses aqueous production
what is the maintenance treatment for ACAG?
oral acetozolamide
what is used as topical aqueous suppressors in ACAG?
beta blockers + alpha agonists
what is used to open the drainage angle in ACAG?
Pilocarpine drops, by constricting the pupil
2 surgical preventative measures in ACAG?
- Laser peripheral cridotomy
- surgical iridectomy
Prophylatic topical drops for ACAG?
Phenylphrine
Tropicamide
