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

• 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