Acute Glaucoma


Acute glaucoma

Description, Causes and Risk Factors:

Alternative Name: Acute angle-closure glaucoma.

Abbreviation: AACG.

In the normal eye, the aqueous is produced by the ciliary body (a thickened portion of the vascular tunic of the eye between the choroid and the iris; it consists of three zones; orbiculus ciliaris, corona ciliaris, and ciliary muscle) epithelium, and flows from the posterior chamber (space between the lens and iris) into the anterior chamber through the pupil. It is then drained via the trabecular meshwork at the angle formed between the sclera and peripheral iris. Acute glaucoma occurs when the aqueous drainage angle is occluded (closed off), obstructing aqueous outflow, and causing elevation of lOP (intraocular pressure).

acute glaucoma

Risk Factors may include:

    Hyperopia (shorter axial diameter with “crowded” anterior chamber).

  • Positive family history. If one of your close relatives (mother, father, sister or brother) has had acute glaucoma, you have an increased risk of developing it. This is because eye shape is often inherited. So, if the anatomy of your relative's eye has made them prone to developing acute angle-closure glaucoma, it could be the same case for you.

  • Asian descent.

  • Cataracts.

  • Shallow anterior chamber.

  • Pupil dilation.

About 1 in 1,000 people get acute glaucoma. It is more likely in people over the age of 40 years, and most often happens at around age 60 to 70 years. It is more common in long-sighted people and in women. It is also more common in Southeast Asian and Eskimo people.

Symptoms:

Signs and symptoms may include:

    Your eye might feel hard and tender.

  • Redness of your eye.

  • Blurry vision.

  • Abnormally enlarged pupil.

  • Cloudy cornea.

  • Increased IOP (> 40 mmHg)

  • Sudden, severe pain within your eye and an ache around your eye.The pain may spread around your head and be felt as a severe headache.

  • Some people may even develop nausea, vomiting, or abdominal pain.

Diagnosis:

The diagnosis can be confirmed by an examination done by an ophthalmologist. This usually involves examining your eye using a special light and magnifier called a slit lamp and measuring the pressure in your eye. A special lens can also be used to examine the outflow channels around the trabecular meshwork area of your eye (gonioscopy).

Treatment:

Early diagnosis and prompt treatment are essential to improve the outcome of this potentially blinding disease. The initial course of action is to rapidly try to reduce the IOP and reopen the angle to allow fluid drainage. The rapid lowering of IOP can prevent damage to the optic nerve and iris ischemia, hence improving the chances of reversing the attack.

Management of acute angle closure glaucoma is two-fold, rapid reduction of the acutely raised lOP medically or surgically, and the prevention of future episodes.

Immediate management of acute angle-closure glaucoma may include:

    Oral osmotic agents (if the patient is not suffering form emesis only).

  • Carbonic anhydrase inhibitors - to reduce aqueous production.

  • Miotics - to reverse papillary block.

  • Topical beta blockers.

  • Topical alpha agonists.

  • Dark room - as pupil is usually fixed in mid-dilation.

After the initial attack has subsided, these therapies should be continued until definitive surgical treatment is performed or angle reopening is assured. Prevention is achieved by peripheral iridotomy (a surgical procedure that makes an incision in the iris of the eye in order to enlarge the pupil), where an opening in the peripheral iris is made by laser. This establishes a direct connection between the posterior and anterior chambers for aqueous flow, thus preventing further attacks.

Disclaimer: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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