Acute Primary Angle Closure Glaucoma

Clinical Description

Angle closure glaucoma with abrupt onset

Signs and Symptoms

• Sudden blurry vision
• Redness
• Abrupt onset of severe eye pain (usually unilateral) and headache
• Nausea and vomiting
• Very high intraocular pressure, fixed or mid-dilated pupil

Treatment

• Systemic
• Acetazolamide 500mg IV stat then 250mg PO 6 hourly.
• If IOP is not improving consider systemic hyperosmotic agent (e.g.

mannitol 20% solution IV 1 – 1.5g/kg).

• Ipsilateral eye:
• β-blocker (e.g. timolol 0.5% stat, then every 12hrs).
• Sympathomimetic (e.g. apraclonidine 1% stat).
• Steroid (e.g. prednisolone 1% stat, then every 30–60min).
• Pilocarpine 2% (once IOP <50mmHg, e.g. twice in first hour, then every 6hrs).
• Admit patient
• Surgical treatment (definitive management)
• Bilateral Nd-YAG laser iridotomy or surgical Peripheral iridectomy.