Acute glaucoma

Question 1

Acute glaucoma risk factors

Answer 1

Increasing age
Female sex
East Asian ethnicity
Family history
Hypermetropia (longsightedness)

Question 2

Acute glaucoma symptoms

Answer 2

• Unilateral severe eye pain or headache
• Nausea and vomiting
• Reduction in visual acuity or visual loss
• Rainbow coloured haloes around bright lights

Question 3

Clinical examination in acute glaucoma

Answer 3

• Unilateral conjunctival injection
• Diffusely hazy cornea limiting view of the iris and pupil
• A fixed, non-reactive, mid-dilated pupil
• Very high IOP: this is always >30mmHg but can be as high as 60-80mmHg

Question 4

Acute glaucoma investigations

Answer 4

• Gonioscopy to establish diagnosis
• Tonometry to measure IOP (always over 30)

Question 5

Acute glaucoma conservative management

Answer 5

• Analgesia
• Antiemetics
• Lie patient flat to open anterior chamber angle

Question 6

Specialist management of acute glaucoma

Answer 6

• Systemic pressure-reducing agents: acetazolamide (IV/oral)
• Topical pressure-reducing agents (e.g. beta-blockers)
• Topical steroids to reduce inflammation
• Peripheral iridotomy (a laser hole through the iris) to allow a separate route for aqueous drainage
• Pilocarpine may be considered