Agents for Angle-Closure Glaucoma

HPI AC is a 45-year-old woman who presents to the ED with nausea, vomiting, diaphoresis, and a severely red and painful right eye with steamy -appearing cornea. 

Dilation of the pupil in the preexisting narrow anterior chamber may cause the iris to block aqueous humor outflow via the anterior chamber. This leads to an abrupt increase in lOP, resulting in an acute attack of angle-closure glaucoma. Signs and symptoms include blurred vision (often with colored halos around the light), severe ocular pain, red conjunctiva, diaphoresis, and nausea/vomiting. The cornea may appear cloudy due to edema. Upon presentation, the lOP is frequently above 50 mm Hg. 

Any agents with anticholinergic effects, which may dilate the pupil, should be used with caution in patients predis- 

Case Conclusion AC is started on combination therapy with glycerin, pilocarpine 2%, timolol, and acetazolamide to rapidly reduce the lOP. After the lOP has stabilized, AC is taken to surgery for laser peripheral iridotomy. 

Drug of choice among oral agents use with caution in diabetic patients 

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