Acute Angle Closure Glaucoma

Question 1

What is acute angle closure glaucoma?

Answer 1

• Iris bulges forward and seals off the trabecular meshwork from the anterior chamber preventing aqueous humour from being able to drain away leading to constant build up of pressure -> EMERGENCY

Question 2

What are the risk factors for acute angle closure glaucoma?

Answer 2

• Increasing age
• Females
• Family history
• Chinese and East-Asian origin
• Certain medications including noradrenalin, anticholinergics and TCA e.g. amitriptyline

Question 3

How does acute angle closure glaucoma present?

Answer 3

• Severely painful red, teary eye
• Blurred vision
• Halos around lights
• Headaches, nausea and vomiting
• Decreased visual acuity
• Fixed pupil size and firm eyeball on palpation

Question 4

What is the initial management of AACG?

Answer 4

• Lie patient on back without pillow
• Pilocarpine eye drops (2% for blue eyes and 4% for brown)
• Acetazolamide (carbonic anhydrase inhibitor) 500mg orally (reduces production of aqueous humour)
• Analgesia and anti-emetic if needed

Question 5

How is AACG managed in secondary care?

Answer 5

• IV Acetazolamide/Topical pilocarpine/Beta-blockers/Steroids all used to reduce intraocular pressure
• Surgical procedures such as iridotomy, iridoplasty
• Aims of treatment are to reduce pressure, ease symptoms and preserve sight

Question 6

How does pilocarpine work?

Answer 6

• Acts of the muscarinic receptors in the iris to cause constriction of pupil and ciliary muscle to open up pathway of aqueous humour