Acute-Angle Closure Glaucoma Treatment

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.