1. Acute closed-angle Glaucoma

Definition: 

• The angle between the iris and cornea is too small. Impairing aqueous outflow
• Affects 0.4% of over-40-year-olds in the UK.

Rf’s/Etiology:

• Hypermetropia, mydriasis, lens growth associated with age, females, Asian ethnicity, and medications (antihistamines, antiparkinsonian medications, antipsychotics, benzodiazepines, botulinum toxin, cocaine, H2 receptor antagonists, mefenamic acid, SSRIs, topiramate, tricyclic antidepressants).

Symptoms: 

• Unilateral pain, red eye, decreased visual acuity, haloes around light, systemic upset (n+v, frontal headache, Abdo pain)

Precipitating Factors:

• g. pupils dilating while watching TV at night, or long-sighted pt’s, history of subacute attacks, entering a dark room (relieved by sleep)

Investigations/Signs:

• semi-dilated non-reacting pupil (oval shaped), corneal oedema (hazy/dull), decreased VA,

Treatment:

• THINK ADMIT!! – Emergency referral to ophthalmology
• Before surgery (laser peripheral iridotomy) – a combo of eye drops Pilocarpine 4% (increased outflow of aqueous) & Acetazolamide +/- apraclonidine and or latanoprost
• If not possible to admit, then temporarily treat in primary care:
  lay flat & face up
  Pilocarpine drops (2% for blue & 4% for brown eyes)
  Acetazolamide 500mg PO o Analgesics & Anti-emetics if required