Diferencia entre revisiones de «Acute angle-closure glaucoma»
m (Rossdonaldson1 moved page Acute Angle-Closure Glaucoma to Acute angle-closure glaucoma) |
Sin resumen de edición |
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| Línea 1: | Línea 1: | ||
= Background = | == Background== | ||
Pathophysiology | ===Pathophysiology=== | ||
*Obstructed aqueous outflow tract > aqueous humor builds > increased intraocular pressure (IOP) > optic nerve damage > vision loss | *Obstructed aqueous outflow tract > aqueous humor builds > increased intraocular pressure (IOP) > optic nerve damage > vision loss | ||
*Increased posterior chamber pressure causes iris to bulge forward (iris bombé) > further obstruction of outflow tract > further increase IOP | *Increased posterior chamber pressure causes iris to bulge forward (iris bombé) > further obstruction of outflow tract > further increase IOP | ||
*Acute attack is usually precipitated by pupillary dilation | *Acute attack is usually precipitated by pupillary dilation | ||
=Definition: 3 signs + 2 symptoms= | ===Definition: 3 signs + 2 symptoms=== | ||
*At least 3 of these signs: | *At least 3 of these signs: | ||
**IOP >21 mm Hg | **IOP >21 mm Hg | ||
| Línea 17: | Línea 17: | ||
**History of intermittent blurring of vision with halos | **History of intermittent blurring of vision with halos | ||
= Clinical Features = | == Clinical Features == | ||
*Abrupt onset of severe eye pain | *Abrupt onset of severe eye pain | ||
*Blurred vision | *Blurred vision | ||
| Línea 23: | Línea 23: | ||
*Nausea / vomiting / abdominal pain | *Nausea / vomiting / abdominal pain | ||
=Diagnosis= | ==Differential Diagnosis== | ||
==Diagnosis== | |||
*Fixed, midposition pupil | *Fixed, midposition pupil | ||
*Hazy cornea | *Hazy cornea | ||
| Línea 31: | Línea 33: | ||
*SLIT LAMP exam shows ''Cell and Flare'' which represents visualization of individual cells in the shallow anterior chamber | *SLIT LAMP exam shows ''Cell and Flare'' which represents visualization of individual cells in the shallow anterior chamber | ||
= Treatment = | == Treatment == | ||
*Emergent ophthalmology consult | *Emergent ophthalmology consult | ||
*Decrease production of aqueous humor: | *Decrease production of aqueous humor: | ||
| Línea 39: | Línea 41: | ||
*Facilitate outflow of aqueous humor: | *Facilitate outflow of aqueous humor: | ||
#'''pilocarpine 1%–2% drop''': parasympatholytic alkaloid acts on muscarinic receptors found on iris sphincter muscle ==> causes muscle to contract ==> miosis | #'''pilocarpine 1%–2% drop''': parasympatholytic alkaloid acts on muscarinic receptors found on iris sphincter muscle ==> causes muscle to contract ==> miosis | ||
# | #*In USA - green top | ||
# | #*Use one drop every 15 minutes x 2 doses, then every 4 to 6 hours | ||
# | #*Only effective when IOP <40 mm Hg | ||
*Reduce volume of aqueous humor: | *Reduce volume of aqueous humor: | ||
#'''mannitol 1–2gm/kg IV''': if no contraindications | #'''[[mannitol]] 1–2gm/kg IV''': if no contraindications | ||
*Recheck IOP hourly | *Recheck IOP hourly | ||
=See Also= | ==See Also== | ||
*[[Eye Algorithm (Main)]] | *[[Eye Algorithm (Main)]] | ||
= | ==References== | ||
[[Category:Ophtho]] | [[Category:Ophtho]] | ||
Revisión del 20:32 3 jun 2015
Background
Pathophysiology
- Obstructed aqueous outflow tract > aqueous humor builds > increased intraocular pressure (IOP) > optic nerve damage > vision loss
- Increased posterior chamber pressure causes iris to bulge forward (iris bombé) > further obstruction of outflow tract > further increase IOP
- Acute attack is usually precipitated by pupillary dilation
Definition: 3 signs + 2 symptoms
- At least 3 of these signs:
- IOP >21 mm Hg
- Conjunctival injection
- Corneal epithelial edema
- Mid-dilated nonreactive pupil
- Shallow anterior chamber with occlusion
- At least 2 of these symptoms:
- Ocular pain
- Nausea/vomiting
- History of intermittent blurring of vision with halos
Clinical Features
- Abrupt onset of severe eye pain
- Blurred vision
- Frontal or supraorbital headache
- Nausea / vomiting / abdominal pain
Differential Diagnosis
Diagnosis
- Fixed, midposition pupil
- Hazy cornea
- Conjunctival injection most prominent at limbus (ciliary flush)
- Rock-hard globe
- IOP >20 mm Hg
- SLIT LAMP exam shows Cell and Flare which represents visualization of individual cells in the shallow anterior chamber
Treatment
- Emergent ophthalmology consult
- Decrease production of aqueous humor:
- timolol 0.5% drop: blocks beta receptors on ciliary epithelium
- apraclonidine 1% drop: alpha-2 adrenergic receptor agonist which increases trabecular outflow
- acetazolamide 500mg IV or PO: blocks productions of HCO3-, which draws Na+ into the eye; water follows by osmosis to form aqueous humour
- Facilitate outflow of aqueous humor:
- pilocarpine 1%–2% drop: parasympatholytic alkaloid acts on muscarinic receptors found on iris sphincter muscle ==> causes muscle to contract ==> miosis
- In USA - green top
- Use one drop every 15 minutes x 2 doses, then every 4 to 6 hours
- Only effective when IOP <40 mm Hg
- Reduce volume of aqueous humor:
- mannitol 1–2gm/kg IV: if no contraindications
- Recheck IOP hourly