Sudden rise in intraocular pressure from blocked aqueous outflow — sight-threatening emergency.
Risk factors
- • Female, age >60
- • Hypermetropia
- • Asian ethnicity
- • Pupil dilation (mydriatics, dim light)
Clinical features
- • Severe eye pain
- • Headache, nausea, vomiting
- • Blurred vision, haloes around lights
Examination
- • Fixed mid-dilated pupil
- • Red eye, hazy cornea
- • Hard eye on palpation
- • IOP >40 mmHg
Investigations
- • Tonometry
- • Gonioscopy
- • Slit lamp
Differential diagnosis
- • Migraine
- • Cluster headache
- • Anterior uveitis
- • Acute conjunctivitis
Management
- • Lie supine
- • Pilocarpine 2% drops
- • Acetazolamide 500 mg IV/PO
- • Timolol + apraclonidine + dexamethasone drops
- • Definitive: laser peripheral iridotomy
Drug therapy
- • Acetazolamide 500 mg + 250 mg q6h
- • Mannitol 20% 1 g/kg if refractory
Complications
- • Permanent vision loss
- • Optic nerve atrophy
Clinical pearls
- • Never dilate a red painful eye
Related in WardRound
Educational — verify locally.
