Acute angle-closure glaucoma

Diagnosis

• Pathophysiology
  • Obstructed aqueous humor outflow leads to incr IOP -> optic neuropathy and vision loss
    • Posterior chamber pressure increases, causing iris to bulge forward (iris bombe)
      • This further decreases the angle and increases the IOP
• Acute attack is usually precipitated by pupillary dilation
• 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

Clinical Features

1. Abrupt onset of severe pain in affected eye
2. Blurred vision
3. Frontal or supraorbital headache
4. N/V

Diagnosis

1. Fixed, midposition pupil
2. Hazy cornea
3. Conjunctival injection (most prominent at limbus)
4. Rock-hard globe
   1. IOP >20

Treatment

1. Emergent ophtho consult
2. Block aqueous humor production
   1. Timolol 0.5%, one drop AND
   2. Apraclonidine 1%, one drop AND
   3. Acetazolamide 500mg IV or PO
3. Reduce volume of aqueous humor
   1. Mannitol 1–2gm/kg IV
4. Recheck IOP hourly
5. Facilitate outflow of aqueous humor
   1. Only effective once IOP <40
   2. Pilocarpine 1%–2%, one drop q15min x2 doses; then QID

Source

Tintinalli