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Closed angle Glaucoma
A.k.a. Acute angle closure glaucoma
- Due to blockage of aqueous outflow by iris sealing against cornea
Epidemiology
- more common in women
- Disease of middle age to later life
- prevalence 1:1000 over 40 years
Risk Factors
- hypermetropia (long sight)
- family history
- previous attack in other eye
History
- may be precede by subacute attacks
- in evening
- relieved when asleep
- Sudden obstruction
- usually in evening
- agonising pain
- impaired vision
- leads to rapid increase intraocular pressure and pain
- Acute attack commonly preceded by blurred vision or haloes around lights
(early corneal oedema)
Examination
- eye red and exquisitely painful
- Cornea may be hazy due to oedema
- intraocular pressure up to 80mmHg
- oval pupil
- pentorch illumination from side shows iris bowed forward
Treatment
- Mannitol can be used in an emergency
- Pilocarpine 2-4% hourly
- Acetazolamide 500mg PO (or IM) then 250mg /8h PO
- Need to check other eye as is likely to have narrow canal predisposing to
AACG there as well.
- Laser surgery can make a hole in the iris to allow drainage of aqueous
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