From the Guidelines
Acute angle closure glaucoma is a serious eye emergency that requires immediate treatment, typically beginning with medications to lower eye pressure, followed by laser peripheral iridotomy to create a small hole in the iris and allow fluid flow. The symptoms of acute angle closure glaucoma include sudden severe eye pain, redness, blurred vision, seeing halos around lights, headache, nausea, and vomiting, which occur when the drainage angle in the eye suddenly becomes blocked, causing rapid increase in intraocular pressure 1. Some key points to consider in the management of acute angle closure glaucoma include:
- The use of medical therapy, including aqueous suppressants, parasympathomimetics, and osmotic agents, to lower the intraocular pressure acutely and relieve symptoms 1
- The importance of performing laser iridotomy as soon as possible to relieve pupillary block and prevent or retard the formation of peripheral anterior synechiae (PAS) 1
- The need to consider the fellow eye for prophylactic iridotomy, as there is a high risk of developing the condition in both eyes 1
- The potential use of alternative treatments, such as lens extraction, in some patients with primary angle closure (PAC) and primary angle-closure glaucoma (PACG) 1 Some of the medications used to treat acute angle closure glaucoma include:
- Oral carbonic anhydrase inhibitors, such as acetazolamide 500mg
- Topical beta-blockers, such as timolol 0.5%
- Alpha-agonists, such as brimonidine 0.2%
- Prostaglandin analogs, such as latanoprost 0.005%
- IV or oral osmotic agents, such as mannitol (1-2g/kg IV) or glycerol, to rapidly reduce pressure 1. It is essential to seek emergency medical care immediately if symptoms of acute angle closure glaucoma occur, as prompt treatment can help prevent permanent vision loss due to damage to the optic nerve from sustained high pressure 1.
From the FDA Drug Label
For adjunctive treatment of: ... preoperatively in acute angle-closure glaucoma where delay of surgery is desired in order to lower intraocular pressure. The preferred dosage is 250 mg every four hours, although some cases have responded to 250 mg twice daily on short-term therapy In some acute cases, it may be more satisfactory to administer an initial dose of 500 mg followed by 125 or 250 mg every four hours depending on the individual case.
The symptoms of acute angle closure glaucoma are not explicitly stated in the provided drug labels. However, the treatment of acute angle closure glaucoma involves the use of acetazolamide, with a preferred dosage of 250 mg every four hours, or an initial dose of 500 mg followed by 125 or 250 mg every four hours depending on the individual case 2 2. Key points:
- Acetazolamide is used as an adjunct to the usual therapy for acute angle closure glaucoma.
- The dosage should be adjusted with careful individual attention both to symptomatology and ocular tension.
- Continuous supervision by a physician is advisable.
From the Research
Symptoms of Acute Angle Closure Glaucoma
- Eye redness
- Worsening of vision and other visual disturbances
- Headache
- Nausea
- Severe eye pain
- Blurred vision
- A medium-sized and rigid pupil
- Conjunctival hyperemia
- Halos around lights
- Vomiting
Treatment of Acute Angle Closure Glaucoma
- Pressure-lowering topical and systemic medications
- Surgical interventions, especially cataract surgery and laser iridotomy
- Parasympathomimetics (pilocarpine)
- Beta-receptor antagonists
- Carbonic anhydrase inhibitors
- Alpha-2 selective adrenergic antagonists
- Prostaglandins and prostaglandin analogues
- Systemic use of carbonic anhydrase inhibitors and osmotic agents (e.g., mannitol)
- The goals of treatment are to reduce the elevated intraocular pressure rapidly and to eliminate the situation that led to closed-angle glaucoma 3
- Proper, specific treatment can help patients rapidly and lastingly 3
- It is necessary to pay attention to changes in the optic disc as well as the IOP after performing laser iridotomy 4
Causes of Acute Angle Closure Glaucoma
- Certain anatomical configurations of the eye
- Pupillary block, which can be caused by adrenergic agents, drugs with anticholinergic effects, and cholinergic agents 5
- Ciliary body edema with anterior rotation of the iris-lens diaphragm, which can be caused by sulfa-based drugs 5
- Not all predisposing factors have been definitively identified 3
Importance of Prompt Treatment
- Acute angle closure glaucoma is an ophthalmological emergency that can cause permanent vision damage if not treated promptly 3
- Rapid assessment and diagnosis of AACG allowed prompt treatment and likely prevented the patient from losing her vision 6
- The patient should be seen by an ophthalmologist without delay, on the day of symptom onset if possible 3