Daily Bolus of LR: Acute Angle Closure Glaucoma

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November 10, 2011 by dailybolusoflr

Acute Angle Closure Glaucoma


Typical Presentation

·         Severe onset of pain, often described as unilateral headache or more focally may be described as eye pain

·         Typical board case is that of a patient who went into a dark location (think movie theater) and had an attack which is precipitated by dilation of the pupil

·         Possible complaints of blurred vision or that they see “halos” around lights


Physical Examination

·         Unilateral red eye with congested vessels

·         Mid dilated, non-reactive pupil

·         IOP usually high (usually over 60 mm Hg, but anything over the normal of 20 mm Hg should be suspicious in the right clinical setting as IOP can drop with prolonged presentations due to ischemia of the ciliary body and decreased aqueous production)



·         Ophthalmologic consultation for definitive management

·         Decrease the IOP by three mechanisms

1. Decrease the aqueous production (topical beta blockers; acetazolamide po)

2. Increase aqueous outflow (topical pilocarpine)

3. Reduce vitreous volume with dehydrating agents (mannitol IV)

Ref: Harwood Nuss 5th edition

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