acute close angle glaucoma

Question 1

what is glaucoma?

Answer 1

• refers to optic nerve damage that is caused by a significant rise in intraocular pressure
• the rise in pressure caused by a blockage in aqueous humour trying to escape the eye

Question 2

what causes acute angle closure glaucoma?

Answer 2

• occurs when the iris bulges forward and seals off the trabecular meshwork from the anterior chamber preventing aqueous humour from being able to drain away
• this leads to a continual build up pressure in the eye
• the pressure builds up particularly in the posterior chamber, which causes pressure behind the iris and worsens the closure of the angle

Question 3

is acute angle closure glaucoma routine or emergency?

Answer 3

EMERGENCY!!!!

-emergency treatment is required to prevent permanent vision loss

Question 4

what is the difference between the pathophysiology of open and closed angle glaucoma?

Answer 4

open angle- increase in resistence in trabecular meshwork causing an increase in pressure

closed angle- iris bulges over and seals off the trabeclar meshwork

Question 5

what are risk factors for acute close angle glaucoma?

Answer 5

• increase in age
• females 4 x more than males
• family history
• shallow anterior chamber
• chinese and east asia (rare in black ethnic origin)

Question 6

what medications can precipitate acute angle-closure glaucoma?

Answer 6

• adrenergic medications such as noradrenalin
• anticholinergic medications such as oxybutin and solifenacin
• tricyclin antidepressants such as amitriptyline

Question 7

how does acute angle closure glaucoma present?

Answer 7

ACUTE!

• generally unwell
• severely painful red eye
• blurred vision
• halos around lights
• associated headaches, nausea and vomiting

Question 8

what is seen in acute angle closure glaucoma on examination?

Answer 8

• red eye
• teary
• hazy cornea
• decreased visual acuity
• fixed pupil size
• eyeball firm on palpation

Question 9

what are the NICE guidelines for potential life threatening causes of red eye?

Answer 9

-they should be referred the same day for assessment by ophthomolagist

acute closed angle glaucoma is a potential life threatening cause of red eye

Question 10

what is usually the treatment for acute angle closure glaucoma?

Answer 10

• urgent referral to ophthomolagist
• laser iridotomy

(this involves using a laser to make a hole in the iris to allow the aqueous humour to flow from the posterior chamber into the anterior chamber releiving pressure)

Initial emergency management:

• eye drops
• IV acetazolamide