Acute angle-closure glaucoma: Difference between revisions
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****This further decreases the angle and increases the IOP | ****This further decreases the angle and increases the IOP | ||
*Acute attack is usually precipitated by pupillary dilation | *Acute attack is usually precipitated by pupillary dilation | ||
== Clinical Features == | == Clinical Features == | ||
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#Reduce volume of aqueous humor | #Reduce volume of aqueous humor | ||
##Mannitol 1–2gm/kg IV | ##Mannitol 1–2gm/kg IV | ||
# | ##Give if no contraindications | ||
#Facilitate outflow of aqueous humor | #Facilitate outflow of aqueous humor | ||
##Only effective once IOP <40 | ##Only effective once IOP <40 | ||
##Pilocarpine 1%–2%, one drop q15min x2 doses; then QID | ##Pilocarpine 1%–2%, one drop q15min x2 doses; then QID | ||
#Recheck IOP hourly | |||
==Source== | ==Source== | ||
Revision as of 19:34, 28 October 2011
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
- Posterior chamber pressure increases, causing iris to bulge forward (iris bombe)
- Obstructed aqueous humor outflow leads to incr IOP -> optic neuropathy and vision loss
- Acute attack is usually precipitated by pupillary dilation
Clinical Features
- Abrupt onset of severe pain in affected eye
- Blurred vision
- Frontal or supraorbital headache
- N/V
Diagnosis
- Fixed, midposition pupil
- Hazy cornea
- Conjunctival injection (most prominent at limbus)
- Rock-hard globe
- IOP >20
Treatment
- Emergent ophtho consult
- Block aqueous humor production
- Timolol 0.5%, one drop AND
- Apraclonidine 1%, one drop AND
- Acetazolamide 500mg IV or PO
- Reduce volume of aqueous humor
- Mannitol 1–2gm/kg IV
- Give if no contraindications
- Facilitate outflow of aqueous humor
- Only effective once IOP <40
- Pilocarpine 1%–2%, one drop q15min x2 doses; then QID
- Recheck IOP hourly
Source
Tintinalli