From the Guidelines
Acute onset glaucoma is a medical emergency that requires immediate treatment with medications to rapidly lower intraocular pressure, followed by definitive treatment with laser peripheral iridotomy, as recommended by the most recent guidelines 1.
Treatment Approach
The treatment approach for acute onset glaucoma involves several steps:
- Initial treatment with medications to rapidly lower intraocular pressure, including topical beta-blockers like timolol 0.5% drops, alpha-agonists such as brimonidine 0.2%, and carbonic anhydrase inhibitors like acetazolamide 500mg orally or IV 1.
- Use of hyperosmotic agents like mannitol 1-2g/kg IV in severe cases 1.
- Administration of pilocarpine 2-4% to help open the drainage angle once pressure begins to decrease 1.
- Definitive treatment with laser peripheral iridotomy to create a small hole in the iris and allow fluid flow between the posterior and anterior chambers 1.
Importance of Prompt Treatment
Prompt treatment is crucial to prevent permanent optic nerve damage and vision loss, which can occur within hours if left untreated 1.
Risk Factors and Symptoms
Risk factors for acute onset glaucoma include advanced age, female gender, Asian ethnicity, hyperopia, and family history 1. Symptoms of acute onset glaucoma include severe eye pain, headache, blurred vision, halos around lights, nausea, and vomiting 1.
Clinical Objectives
The clinical objectives for managing acute onset glaucoma include identifying patients at risk, successfully managing acute angle-closure crisis, preventing or reversing angle closure, and evaluating the fellow eye for evidence of angle closure 1.
From the Research
Definition and Causes of Acute Onset Glaucoma
- Acute onset glaucoma, also known as acute closed-angle glaucoma, is a medical emergency that requires immediate attention 2.
- It is characterized by a sudden increase in intraocular pressure, which can cause damage to the optic nerve and lead to vision loss if left untreated.
Symptoms and Diagnosis
- Symptoms of acute onset glaucoma include severe eye pain, blurred vision, headache, and nausea 3.
- Diagnosis is typically made through a combination of medical history, physical examination, and diagnostic tests such as measurement of intraocular pressure, perimetry, and optical coherence tomography 3.
Treatment Options
- Treatment for acute onset glaucoma typically involves a combination of medications, including miotics, beta-blockers, and carbonic anhydrase inhibitors, to reduce intraocular pressure 2, 4.
- Topical timolol alone may not be effective enough to control intraocular pressure in acute closed-angle glaucoma, but a good hypotensive effect can be seen when topical timolol is followed by pilocarpine 2.
- Laser and surgical procedures may also be necessary to reduce intraocular pressure and prevent further damage to the optic nerve 5, 4.
Management and Prevention
- Management of acute onset glaucoma requires close monitoring of intraocular pressure and adjustment of treatment as needed 2, 6.
- Prevention of acute onset glaucoma involves regular eye examinations to detect any underlying conditions that may increase the risk of developing glaucoma, such as narrow angles or high intraocular pressure 5, 3.