Study Material on Angle-Closure Glaucoma - Treatment and Follow-Up Protocols

Acute angle-closure glaucoma is generally a [bilateral/unilateral] phenomenon and is frequently caused by ___ ___ or ___ ___ syndrome.

unilateral, pupillary block, plateau iris

If ___ ___ is suspected, the fellow eye should be evaluated for a narrow angle.

pupillary block

Primary angle-closure glaucoma (PACG) more commonly occurs in [females/males].

females

Patients with a ____ refractive error, especially those that are of South-East ___, ___, or ___descent, also have a higher predilection for PACG

hyperopic, Asian, Inuit, Chinese

Patients with a family history of the disease, particularly _____ relatives, are at a higher risk for developing PACG.

first-degree

PACG Symptoms

- Blurred vision

- Ocular ____

- ___ ___

- A ___ ___

- ___ and ___

- The perception of ___ ___ around light sources

pain , Conjunctival injection, frontal headache, Nausea, vomiting, colored halos

Clinical Signs of PACG:

- A ___ and ___ pupil

- A ____ anterior chamber

- ___ ___

- ___ ___

fixed, dilated, shallow, Elevated IOP, Corneal edema

Unless contraindicated, patients suffering from acute angle-closure should be treated as follows

- 1 drop of ____ ___%,

- 1 drop of ___ ___%,

- 1 drop of ____ ___%, and

- ____ ____ mg by mouth

timolol 0.5, pilocarpine 2, apraclonidine 1, Acetazolamide (diamox) 500

PACG treatment: The IOP should be remeasured every ____ minutes

15-30

PACG treatment: If the IOP remains elevated after 1 hour post-treatment, then repeat the above protocol (excluding _____) adding an oral hyperosmotic such as ___ or ___ (for diabetic patients)

acetazolamide, glycerin, isosorbide

PACG treatment: By placing a ____ ___ lens on the eye and applying pressure, one can also attempt to open the angle; LPIs are not typically recommended until the ___ ___ has resolved

4-mirror gonio, corneal edema

PACG treatment: If the IOP remains high after 2 hours post-treatment, then an ___ ___ ___ is recommended; should the IOP remain elevated 4-6 hours after the initiation of treatment, an ___ ___ should be performed

Argon laser gonioplasty, emergency LPI

PACG treatment: If the IOP responds to treatment by dropping below ____mmHg, ____ should be performed to verify that the angle is open

20 , gonioscopy

PACG treatment: Once the angle is verified as open, the patient should be prescribed:

- ____ ____% q.i.d.

- ____ ____ ___% q.i.d. for ____ days until an LPI may be performed; in addition to the above drops, many practitioners add a topical ___ ___ b.i.d. which serves to decrease aqueous production

Pilocarpine 2, Prednisolone acetate 1, 2-7, beta blocker

PACG treatment: The use of pilocarpine for pressures over 40 mmHg remains controversial because IOPs that are 40 mmHg or above do not respond to a miotic due to ____ of the ___ ___ muscle ; however, most clinicians believe that immediate administration of pilocarpine allows for increased availability of this medication in the anterior chamber when the IOP becomes reduced

ischemia, iris sphincter

PACG f/u: After the IOP has been lowered, the patient should return in ___ ___ for follow-up

one day

PACG f/u: Once the intraocular pressure is stabilized and the structures of the anterior chamber have recovered, the patient should undergo an ____, which should be followed by an LPI of the ___ ___ in one or two weeks' time; an LPI should not be performed less than ____ days after management of the angle attack has been initiated to allow for proper recovery of the anterior chamber and its associated structures

LPI, fellow eye, 2

Certain medications such as some oral _____, along with a variety of ____ medications, can lead to mydriasis; therefore, people who have anatomically narrow angles may experience angle closure with use of these meds

antihistamines, antipsychotic

Situations in which illumination is ____ and tasks that require ____ may also provoke closure of the angle

dim, accommodation