Acute angle-closure glaucoma: Difference between revisions
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== Diagnosis == | == Diagnosis == | ||
*IOP >30, usually higher (no definitive cut-off) | *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 | *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 | ||
== Symptoms == | == Symptoms == | ||
#headache, ocular, facial pain | |||
#nausea/vomiting | |||
#visual acuity change, seeing "halos" | |||
== Treatment == | == Treatment == | ||
# emergent ophthalmic consult | |||
# ocular massage | |||
# IOP > 40mmHg | |||
## immediately treat with timolol 0.5% concentration and/or apraclonidine 1% | |||
#IOP < 40mmHg: above plus... | |||
IOP > 40mmHg | ## 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 | |||
IOP < 40mmHg: above plus... | ## prednisolone acetate 1% QID | ||
## oral acetazolamide 500mg BID | |||
IOP < 30mmHg (maintenance): | |||
Definitive | Definitive | ||
- surgical iridectomy | - surgical iridectomy | ||
^Most miotics are ineffective at IOP > 40mmHg due to iris ischemia | |||
[[Category:Ophtho]] | |||
Revision as of 09:47, 29 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