Acute Glaucoma

Question 1

Acute Glaucoma

Answer 1

• sight-threatening emergency caused by rapid rise in intraoccular pressure
• due to sudden obstructionof aqueous humour outflow

Question 2

Risk factors for acute glaucoma

Answer 2

• anatomy (shallow ant. chamber, narrow iridocorneal angle, thick peripheral iris)
• elderly
• women
• long-sighted (myopia)
• chinest and East Asian
• family history
• medications (anything dilating pupil - adrenergics, anticholinergics)

Question 3

Pathophysiology of acute glaucoma

Answer 3

1. iris bulges forward and seals off trabecular meshwork from anterior chamber
2. prevents drainage of aqueous humour
3. increased intraocular pressure in posterior chamber

Question 4

Clinical features of glaucoma

Answer 4

• severely painful red eye
• blurred vision
• halos around lights
• headache, nausea, vomiting

Question 5

Examination findings in acute glaucoma

Answer 5

• red, teary eye
• hazy cornea
• mid-dilated, fixed pupil
• firm eyeball on palpation
• decreased visual acuity

Question 6

Investigating acute glaucoma

Answer 6

Occular exam
- reduced VA
- mid-dilated, non-reactive pupil
- hazy cornea, shallow ant. chamber on slit lamp

Tonometry (raised ICP)
Gonioscopy (closed iridocorneal angle)

Question 7

Management of acute glaucoma

Answer 7

Medical treatment (reduce IOP):
1. combination of eye drops (pilocarpine, timolol, apraclonidine)
2. IV acetazolamide

Definitive management:
- laser peripheral iridotomy

Question 8

Differentials for acute glaucoma

Answer 8

1. anterior uveitis (painful, red eye, more gradual vision loss, intense photophobia, small, irregular pupil)
2. keratitis (red, painful ete, foreign body sensation, infiltrates on slit lamp)