What is Acute angle-closure glaucoma?

Acute angle-closure glaucoma (AACG) there is a rise in IOP secondary to an impairment of aqueous outflow

Risk factors for Acute angle-closure glaucoma?

• hypermetropia (long-sightedness)
• pupillary dilatation
• lens growth associated with age

What are the symptoms of Acute angle-closure glaucoma?

• severe pain: may be ocular or headache
• decreased visual acuity
• symptoms worse with mydriasis (e.g. watching TV in a dark room)
• hard, red-eye
• haloes around lights
• semi-dilated non-reacting pupil
• corneal oedema results in dull or hazy cornea
• systemic upset may be seen, such as nausea and vomiting and even abdominal pain

What are the investigations of Acute angle-closure glaucoma?

• tonometry to assess for elevated IOP
• gonioscopy (literally looking, oscopy, at the angle, gonio): a special lens for the slit lamp that allows visualisation of the angle

What's the management of Acute angle-closure glaucoma?

• An emergency and should prompt urgent referral to an ophthalmologist
• Emergency medical treatment is required to lower the IOP with more definitive surgical treatment given once the acute attack has settled.

Definitive management - laser peripheral iridotomy (creates a tiny hole in the peripheral iris)

How does optic timolol work for Acute angle-closure glaucoma?

decreases aqueous humour production

What medication groups are used in acute treatment of Acute angle-closure glaucoma?

• a direct parasympathomimetic (e.g. pilocarpine, causes contraction of the ciliary muscle → opening the trabecular meshwork → increased outflow of the aqueous humour)
• a beta-blocker (e.g. timolol, decreases aqueous humour production)
• an alpha-2 agonist (e.g. apraclonidine, dual mechanism, decreasing aqueous humour production and increasing uveoscleral outflow)