Acute angle-closure glaucoma: Difference between revisions
(Created page with "==Diagnosis== - ciliary flush, edematous cornea, pupil mid-dilated and non-reactive - IOP >30, usually higher (no definitive cut-off) - shallow anterior chamber ==Symptom...") |
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- | - 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 | - shallow anterior chamber | ||
| Line 13: | Line 13: | ||
- headache | - headache, ocular, facial pain | ||
- nausea/vomiting | - nausea/vomiting | ||
| Line 28: | Line 28: | ||
- ocular massage | - ocular massage | ||
- timolol- | 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 | - surgical iridectomy | ||
*Most miotics are ineffective at IOP > 40mmHg due to iris ischemia | |||
Revision as of 23:38, 1 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