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Managemeng of Acute Angle Closure Glaucoma
Transcript of Managemeng of Acute Angle Closure Glaucoma
All the usual things, and also remember to exclude Uveitis and Steroid Response Treatment Lie supine
Discontinue any mydriatics
IV Diamox 500mg stat
PO Diamox 250mg qds
Metoclopramide 10mg if required Contraindications If Beta-blockers contraindicated, consider the use of Brimonidine (Aplhagan).
If Diamox is contraindicated, consider substituting 200ml of 20% iv Mannitol. Affected Eye G Pilocarpine 4% QDS
G Dexamethasone 0.1% (Maxidex) 2hrly
G Timolol 0.5% BD
G Apraclonidine 1% (Iopidine) stat
(Pilocarpine can be avoided until the IOP drops below 60mmHg) Fellow Eye G Pilocarpine 1% QDS
G Dexamethasone 0.1% 2hrly after PI Recheck IOP and AC depth in 1hr Attack not broken Recheck IOP and AC depth in 1hr Attack broken Attack not broken Argon laser iridoplasty:
500µm x 200mW x 0.5s
If not diabetic, 200ml of 20% iv Mannitol or 50% glycerol po (1g/kg) Attack not broken Contact consultant.
Options: Laser iridoplasty, laser iridotomy, paracentesis, cyclodiode, GA lens extraction. Attack broken Attack broken Attack broken YAG LASER IRIDOTOMY If iris brown: Argon laser pretreatment:
#20 x 50µm x 0.1s x 100 - 400mW then YAG PI.
The iridotomies should be at least 200µm in size accompanied by a plume of fluid with pigment.
One iridotmy in each peripheral iris at 12 o’clock.
Iopidine 1% stat. Recheck IOPs in 1hr and reassess angles bilaterally PIs patent and angles open Discharge.
Glaucoma team follow-up. PIs not patent / angles still closed / attack not broken Admit on medical therapy for raised IOP and reattempt PIs later.
You may reattempt PI or keep as inpatient until glaucoma team review.