From the Guidelines
If you're experiencing increased pressure in your eye with a history of glaucoma, you should go to the emergency room immediately. This could indicate an acute glaucoma attack, which is a medical emergency that can lead to permanent vision loss if not treated promptly 1. Watch for symptoms such as severe eye pain, headache, blurry vision, seeing halos around lights, nausea, or vomiting.
Key Considerations
- While waiting to get to the ER, sit upright, avoid lying flat, and don't put pressure on the affected eye.
- Continue taking your regular glaucoma medications unless instructed otherwise by a medical professional.
- At the ER, doctors may administer eye drops like timolol or brimonidine to lower pressure quickly, oral medications such as acetazolamide, or perform procedures to relieve pressure 1.
Importance of Prompt Treatment
Prompt treatment is crucial because elevated intraocular pressure can damage the optic nerve rapidly, potentially causing irreversible vision loss within hours. Even if symptoms seem to improve, still seek emergency care as the underlying pressure may remain dangerously high.
Risk Factors and Recommendations
Established risk factors for primary open-angle glaucoma (POAG) include older age, African race or Latino/Hispanic ethnicity, elevated intraocular pressure (IOP), family history of glaucoma, low ocular perfusion pressure, type 2 diabetes mellitus, myopia, and thin central cornea 1. A reasonable initial treatment goal in a POAG patient is to reduce IOP 20% to 30% below baseline and to adjust up or down as indicated by disease course and severity 1.
From the FDA Drug Label
INDICATIONS AND USAGE: Pilocarpine hydrochloride can be used in the medical management of glaucoma, especially open-angle glaucoma, in those cases in which the intraocular pressure can be controlled adequately by the topical administration of pilocarpine In acute (closed-angle) glaucoma, pilocarpine hydrochloride may be used alone, or in combination with other cholinergic agents or carbonic anhydrase inhibitors, to relieve tension prior to emergency surgery.
For a patient with a history of glaucoma experiencing pressure in the eye, emergency treatment may be necessary.
- The patient should be sent to the Emergency Room (ER) for immediate evaluation and treatment.
- Ophthalmologic consultation is recommended to assess the patient's condition and determine the best course of treatment.
- The use of pilocarpine hydrochloride may be considered to relieve tension in acute (closed-angle) glaucoma, but this should be done under the guidance of an ophthalmologist 2.
From the Research
Emergency Department Procedures for Pressure in the Eye with a History of Glaucoma
The following procedures are recommended for a patient with a history of glaucoma presenting with pressure in the eye:
- Administer topical medications such as dorzolamide or brinzolamide to lower intraocular pressure (IOP) 3
- Consider oral acetazolamide as an adjunct to topical therapy to lower IOP 4
- Use miotics such as pilocarpine in combination with timolol to control IOP in acute closed-angle glaucoma 5
- Monitor the patient's IOP and adjust treatment as necessary to prevent progression of visual field defects 6
Medication Options
Some medication options for glaucoma include:
- Topical carbonic anhydrase inhibitors such as dorzolamide and brinzolamide 3
- Beta adrenergic antagonists such as timolol 5, 7
- Prostaglandin analogs, cholinergic agonists, and sympathomimetics to increase aqueous humor outflow 7
- Oral acetazolamide as an adjunct to topical therapy 4
Important Considerations
When treating a patient with glaucoma, it is essential to: