Emergency management:
angle-closure glaucoma
Desirée Murray Acute angle-closure glaucoma is an ophthalmic
Lecturer in
Ophthalmology:
emergency as it can lead to irreversible blindness if
Department of not identified and treated immediately.
Clinical Surgical
Sciences, The
University of the
Presentation be considered as a
DESIRÉE MURRAY
West Indies, Mount The patient may complain of a painful red eye, definitive treatment
Hope, Trinidad and headache, blurred vision, haloes, nausea, vomiting for patients with
Tobago, West Indies. and abdominal pain (sometimes misdiagnosed as co-existing cataract
gastroenteritis). Precipitating factors include dim and presenting IOP Figure 2 Peripheral iridotomy
light and certain drugs (e.g., bronchodilators, cough >55 mmHg.1 After
mixtures, cold and flu medication, antidepressants, the acute attack is successfully treated with medication,
antihistamines and anticonvulsants). the cataract is replaced by a thinner artificial lens
implant, thereby relieving the pupil block.
Examination
Examination findings include conjunctival injection In other patients, the basis of treatment is an iridotomy:
around the cornea (red eye), mid-dilated nonreactive the creation of a hole in the peripheral iris (Figure 2),
pupil, corneal haze, diminished red reflex and a hard either surgically or using a laser. This bypasses the pupil
Figure 1 Clinical globe, with intraocular pressure (IOP) of between 50 block and reestablishes flow from the posterior to the
findings in acute anterior chamber. If the other eye is at risk, iridotomy is
and 80 mmHg. Central retinal artery and central retinal
angle-closure performed in both eyes.
vein occlusion may also occur.
glaucoma.
Protocol How to prepare for this emergency
Red eye Treatment goal: immediate Put together an acute angle-closure glaucoma
lowering of IOP and alleviation of emergency kit containing all the medication (see
inflammation, pain, nausea. panel),2 needles and syringes that may be needed.
Include a copy of the treatment protocol and the
1. Relieve pupil block. Ask the
contact details of the nearest ophthalmologist. This
patient to lie down on her or
will ensure that you and your team are prepared.
N DU TOIT AND L VAN ZYL, 2013