Glaucoma

Question 1

Acute glaucoma

Answer 1

should always be considered in a patient over 50 yrs presenting with an acutely painful red eye.

Permanent damage will result from misdiagnosis.

The attack characteristically strikes in the evening when the pupil becomes semidilated.

Question 2

Features

Answer 2

Patient >50 yrs

Pain in one eye

± Nausea and vomiting

Impaired vision

Haloes around lights

Fixed semi-dilated pupil

Eye feels hard

Question 3

Management

Answer 3

Urgent ophthalmic referral is essential

• since emergency treatment is necessary to preserve eyesight.

If immediate specialist attention is unavailable, treatment can be initiated with:

acetazolamide (Diamox) 500 mg IV

and

pilocarpine 4% drops to constrict the pupil.