Open / Closed-angle glaucoma

Question 1

Acute Closed Angle Glaucoma Presentation

Answer 1

Severe painful red eye
Fixed, mid dilated pupil
Blurred vision
Halos around lights
Associated headache, nausea and vomiting
Hard eyeball

Question 2

What is angle closure glaucoma?

Answer 2

Angle closure glaucoma is a condition where the anterior chamber angle becomes occluded, leading to sudden or progressive elevation of intraocular pressure and risk of sight loss. This can present acutely as a painful red eye, blurred vision, headache, nausea, and vomiting, or be detected incidentally on routine examination

Question 3

What is the emergency management (hospital) for acute angle closure glaucoma according to NICE?

Answer 3

IV acetazolamide
topical beta-blockers (Timolol), Pilocarpine
steroids

Patients should be referred urgently to ophthalmology for definitive treatment which usually includes laser peripheral iridotomy or surgery

Question 4

What is the primary care management for acute angle closure glaucoma according to NICE?

Answer 4

1. Let the person lie flat with their face up and head not supported by pillows, as this may relieve some of the pressure on the angle.
2. Pilocarpine eye drops, one drop of 2% in blue eyes or 4% in brown eyes; acetazolamide 500 mg orally to reduce production of aqueous humour

Question 5

Glaucoma fundoscopy features

Answer 5

Cupping of optic disc

Question 6

Acute angle glaucoma definitive Mx

Answer 6

Iridotomy - a surgical procedure that creates a tiny hole in the iris, the coloured part of the eye, to improve fluid drainage and reduce intraocular pressure (IOP)

Question 7

How is open angle glaucoma diagnosed?

Answer 7

Diagnosis involves intraocular pressure measurement (Goldmann applanation tonometry), optic nerve assessment, visual field testing, and gonioscopy to confirm open angles

Question 8

Open-angle glaucoma presentaiotns

Answer 8

painless, peripheral vision loss (tunnel vision)

Question 9

What is the first-line treatment for newly diagnosed chronic open angle glaucoma (COAG) according to NICE?


Answer 9

1st line: Offer 360° selective laser trabeculoplasty (SLT)

2nd line: If SLT is declined or unavailable, prostaglandin analogue (Latanoprost) eye drops are first-line

Question 10

What are the main classes of eye drops used for Chronic Open Angle Glucoma?

Answer 10

Prostaglandin analogues: Latanoprost

beta-blockers: Timolol

carbonic anhydrase inhibitors Dorzolamide / Brinzolamide

sympathomimetics Brimonidine

Question 11

At what intraocular pressure is treatment commenced for open angle glaucoma?

Answer 11

24 mmHg and above

Question 12

What is open angle glaucoma?

Answer 12

Open angle glaucoma is a chronic, progressive optic neuropathy characterized by open anterior chamber angles, optic nerve damage, and visual field loss, most commonly associated with raised intraocular pressure