https://wikem.org/w/api.php?action=feedcontributions&feedformat=atom&user=JDMCHM WikEM - User contributions [en] 2026-05-13T22:42:04Z User contributions MediaWiki 1.38.2 https://wikem.org/w/index.php?title=Acute_angle-closure_glaucoma&diff=19739 Acute angle-closure glaucoma 2014-04-14T02:44:04Z <p>JDMCHM: changed apraclonidine...&quot;blocks alpha...&quot; --&gt; &quot;alpha-2...agonist&quot;</p> <hr /> <div>= Background =<br /> Pathophysiology<br /> *Obstructed aqueous outflow tract &gt; aqueous humor builds &gt; increased intraocular pressure (IOP) &gt; optic nerve damage &gt; vision loss<br /> *Increased posterior chamber pressure causes iris to bulge forward (iris bombé) &gt; further obstruction of outflow tract &gt; further increase IOP<br /> *Acute attack is usually precipitated by pupillary dilation<br /> <br /> =Definition: 3 signs + 2 symptoms=<br /> *At least 3 of these signs:<br /> **IOP &gt;21 mm Hg<br /> **Conjunctival injection<br /> **Corneal epithelial edema<br /> **Mid-dilated nonreactive pupil<br /> **Shallow anterior chamber with occlusion<br /> *At least 2 of these symptoms:<br /> **Ocular pain<br /> **Nausea/vomiting<br /> **History of intermittent blurring of vision with halos<br /> <br /> = Clinical Features =<br /> *Abrupt onset of severe eye pain<br /> *Blurred vision<br /> *Frontal or supraorbital headache<br /> *Nausea / vomiting / abdominal pain<br /> <br /> =Diagnosis=<br /> *Fixed, midposition pupil<br /> *Hazy cornea<br /> *Conjunctival injection most prominent at limbus (ciliary flush)<br /> *Rock-hard globe<br /> *IOP &gt;20 mm Hg<br /> <br /> = Treatment =<br /> *Emergent ophthalmology consult<br /> *Decrease production of aqueous humor:<br /> #'''timolol 0.5% drop''': blocks beta receptors on ciliary epithelium<br /> #'''apraclonidine 1% drop''': alpha-2 adrenergic receptor agonist<br /> #'''acetazolamide 500mg IV or PO''': blocks productions of HCO3-, which draws Na+ into the eye; water follows by osmosis to form aqueous humour<br /> *Facilitate outflow of aqueous humor:<br /> #'''pilocarpine 1%–2% drop''': parasympatholytic alkaloid acts on muscarinic receptors found on iris sphincter muscle ==&gt; causes muscle to contract ==&gt; miosis<br /> ##In USA - green top<br /> ##Use one drop every 15 minutes x 2 doses, then every 4 to 6 hours <br /> ##Only effective when IOP &lt;40 mm Hg<br /> *Reduce volume of aqueous humor:<br /> #'''mannitol 1–2gm/kg IV''': if no contraindications<br /> *Recheck IOP hourly<br /> <br /> =See Also=<br /> *[[Eye Algorithm (Main)]]<br /> <br /> =Source=<br /> Tintinalli<br /> <br /> [[Category:Ophtho]]</div> JDMCHM