Acute angle-closure glaucoma

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

1. headache, ocular, facial pain
2. nausea/vomiting
3. visual acuity change, seeing "halos"

Treatment

1. emergent ophthalmic consult
2. ocular massage
3. IOP > 40mmHg
   1. immediately treat with timolol 0.5% concentration and/or apraclonidine 1%
4. IOP < 40mmHg: above plus...
   1. pilocarpine 2% +prednisolone acetate 1% every 15 minutes to abate the attack and reopen the angle
5. IOP < 30mmHg (maintenance):
   1. timolol (or equivalent) 0.5% BID
   2. pilocarpine 2% QID
   3. prednisolone acetate 1% QID
   4. oral acetazolamide 500mg BID

Definitive - surgical iridectomy

^Most miotics are ineffective at IOP > 40mmHg due to iris ischemia