acute closed angle glaucoma

Question 1

occurs when

Answer 1

iris bulges forward and seals off trabecular meshwork

Question 2

where does pressure particularly build up

Answer 2

posterior chamber, causing pressure behind the iris worsening the closure angle

Question 3

risk factors

Answer 3

age
female
FHx
chinese + east asian origin 
shallow anterior chamber

Question 4

medications which can precipitate closed angle glaucoma

Answer 4

adrenergic meds: noradrenalin
anticholinergic medications
tricyclic antidepressants e.g. amitriptyline

Question 5

presentation

Answer 5

unwell
acute onset
-severely painful red eye
-blurred vision 
-halos around lights
-assoc headache, nausea, vomit

Question 6

OE

Answer 6

red eye 
teary 
hazy cornea
decreased visual acuity 
fixed + dilated pupil
firm eyeball on palpation

Question 7

initial Mx

Answer 7

• same day ophthalmology assessment
• lie patient on back w/o pillow
• give pilocarpine eye drops
• give acetazolamide 500mg oral
• analgesia, antiemetics

Question 8

pilocarpine

Answer 8

acts on muscarinic receptors to cause constriction of pupil –> miotic agent

open up flow for aqueous humour

Question 9

acetazolamide

Answer 9

carbonic anydrase inhibitor

reduced production aqueous humour

Question 10

2ry care - medication option

Answer 10

pilocarpine
acetazolamide
hyperosmotics - glycerol, mannitol 
timolol 
dorzolamide
brimonidine - sympathomimetic

Question 11

definitive Mx

Answer 11

laser iridotomy