Acute angle-closure glaucoma: Difference between revisions
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==Diagnosis== | == Diagnosis == | ||
*IOP >30, usually higher (no definitive cut-off) | |||
*deep conjunctival and episcleral injection in a circumlimbal fashion, ciliary flush, edematous "steamy" cornea, pupil mid-dilated and non-reactive | |||
*shallow anterior chamber | |||
== Symptoms == | |||
*headache, ocular, facial pain | |||
*nausea/vomiting | |||
*visual acuity change, seeing "halos" | |||
== Treatment == | |||
==Treatment== | |||
- emergent ophthalmic consult | - emergent ophthalmic consult | ||
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IOP > 40mmHg | IOP > 40mmHg | ||
- immediately treat with timolol 0.5% concentration and/or apraclonidine | - immediately treat with timolol 0.5% concentration and/or apraclonidine 1% | ||
IOP < 40mmHg: above plus... | IOP < 40mmHg: above plus... | ||
- pilocarpine | - pilocarpine 2% +prednisolone acetate 1% every 15 minutes to abate the attack and reopen the angle | ||
IOP < 30mmHg (maintenance): | IOP < 30mmHg (maintenance): | ||
- timolol | - timolol (or equivalent) 0.5% BID | ||
- pilocarpine 2% QID | - pilocarpine 2% QID | ||
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- oral acetazolamide 500mg BID | - oral acetazolamide 500mg BID | ||
Definitive | Definitive | ||
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- surgical iridectomy | - surgical iridectomy | ||
*Most miotics are ineffective at IOP > 40mmHg due to iris ischemia | *Most miotics are ineffective at IOP > 40mmHg due to iris ischemia | ||
<br/>[[Category:Ophtho]] <br/> <br/> | |||
[[Category:Ophtho]] | |||
Revision as of 05:06, 7 March 2011
Diagnosis
- IOP >30, usually higher (no definitive cut-off)
- deep conjunctival and episcleral injection in a circumlimbal fashion, ciliary flush, edematous "steamy" cornea, pupil mid-dilated and non-reactive
- shallow anterior chamber
Symptoms
- headache, ocular, facial pain
- nausea/vomiting
- visual acuity change, seeing "halos"
Treatment
- emergent ophthalmic consult
- ocular massage
IOP > 40mmHg
- immediately treat with timolol 0.5% concentration and/or apraclonidine 1%
IOP < 40mmHg: above plus...
- pilocarpine 2% +prednisolone acetate 1% every 15 minutes to abate the attack and reopen the angle
IOP < 30mmHg (maintenance):
- timolol (or equivalent) 0.5% BID
- pilocarpine 2% QID
- prednisolone acetate 1% QID
- oral acetazolamide 500mg BID
Definitive
- surgical iridectomy
- Most miotics are ineffective at IOP > 40mmHg due to iris ischemia