Acute-Angle Closure Glaucoma Treatment

What is the initial treatment recommended for acute-angle closure glaucoma?

Which medication should be administered first in the polydrug regimen?

What is a possible side effect of Timolol in patients with respiratory conditions?

How often should intraocular pressure (IOP) be measured during treatment?

Which medication can also be given intramuscularly or by mouth if intravenous access is unavailable?

What is the primary purpose of compressing the medial canthus during treatment?

For patients with renal failure, which medication is generally not recommended?

What alternative treatment might be considered if medical therapy for acute-angle closure glaucoma fails?

Acute-Angle Closure Glaucoma

Considered an ocular emergency due to risk of vision loss; requires immediate treatment for optimal results.
Consult an ophthalmologist urgently to manage the condition effectively.

Treatment Medications

Utilize a polydrug regimen with the following medications:
- Timolol 0.5%: Administer 1 drop every 5-15 minutes, repeated 2-3 times in the affected eye only.
  - Be aware of potential systemic absorption leading to adverse effects, especially in patients with conditions like asthma, COPD, bradycardia, and hypotension.
Alpha Agonist Options (administer one):
- Apraclonidine 0.5%: 1 drop every 5-15 minutes, repeated 2-3 times in the affected eye.
- Brimonidine 0.1%-0.2%: 1 drop every 5-15 minutes, repeated 2-3 times in the affected eye.
Apply topical medications solely to the affected eye to minimize systemic exposure.
Acetazolamide: Start with 500 mg IV, then 250 mg every 6 hours.
- Can be administered intramuscularly or orally if IV access is unavailable.

Refractory Treatments

If initial treatments fail, use Mannitol: Administer at 1-2 g/kg via IV infusion over 30-60 minutes.
- Caution: Not recommended for patients with renal failure or pulmonary edema; may worsen congestive heart failure.

Ongoing Monitoring and Additional Treatments

Measure intraocular pressure (IOP) every 60 minutes to evaluate treatment response.
Topical Prednisolone Acetate 1% may reduce corneal edema; consultation with an ophthalmologist is recommended before use.
If medical therapy does not yield results, emergency surgery or laser treatment by an ophthalmologist may be necessary.

This quiz covers the urgent management of acute-angle closure glaucoma, emphasizing the importance of timely treatment to prevent vision loss. It details the medications used, including dosage and administration methods, along with considerations for systemic absorption in vulnerable patients.