Acute angle-closure glaucoma

Since its introduction into clinical practice in 1876, pilocarpine has remained the most usefiil miotic for management of primary open-angle glaucoma, acute angle-closure glaucoma, and many secondary glaucomas. Pilocarpine is commercially arailable as an ophthalmic solution in concentrations from 0.25% to 10% (see Table 10-7). Pilocarpine is also commercially available as a 4% ophthalmic gel that is supplied in 3 5-g tubes. 

Acetazolamide (Diamox) is used in the treatment of simple (open-angle) glaucoma, secondary glaucoma, and preoiteratively in acute angle-closure glaucoma when delay of surgery is desired to lower the IOP These dru ... 

Identify risk factors for the development of chronic open-angle glaucoma and acute angle-closure glaucoma. 

Foreign body in eye Acute angle-closure glaucoma... 

Anti muscarinics Hyperthermia due to blockage of sweating mechanisms, decreased salivation and lacrimation, acute-angle-closure glaucoma in the elderly, urinary retention, constipation, blurred vision, delirium, and hallucinations... 

Topiramate is recently approved by the FDA for migraine prophylaxis. Dose is initiated at 25 mg/day and increased slowly to minimize side effects, which may include paresthesias, fatigue, anorexia, diarrhea, weight loss, difficulty with memory, and nausea. Kidney stones, acute myopia, acute angle-closure glaucoma, and oligohidrosis have been infrequently reported. 

Cardiovascular disease Patients with significant cardiovascular disease may be unable to compensate for transient changes in hemodynamics or rhythm induced by pilocarpine. Pulmonary edema has been reported as a complication of pilocarpine toxicity from high ocular doses given for acute angle-closure glaucoma. Administer... 

Acute angle-closure glaucoma The management of patients with acute angle-closure glaucoma requires therapeutic interventions in addition to ocular... 

Blockers can be used topically to reduce intraocular pressure in patients with chronic open-angle glaucoma and ocular hypertension. The mechanism by which ocular pressure is reduced appears to depend on decreased production of aqueous humor. Timolol has a somewhat greater ocular hypotensive effect than do the available cholinomimetic or adrenomimetic drugs. The 3-blockers also are beneficial in the treatment of acute angle-closure glaucoma. 

Contraindications Acute alcohol intoxication with depressed vital signs, acute angle-closure glaucoma, concurrent use of itraconazole or ketoconazole, myasthenia gravis, severe COPD... 

Isosorbide is an orally active diuretic, most commonly used in the emergency treatment of acute angle-closure glaucoma. 

Antimuscarinic drugs are contraindicated in patients with glaucoma, especially angle-closure glaucoma. Even systemic use of moderate doses may precipitate angle closure (and acute glaucoma) in patients with shallow anterior chambers. 

Acute angle closure glaucoma has been reported as rare complication of rapid insulin therapy for hyperglycemic non-ketotic coma (20). It was postulated that raised glucose concentrations in the lens leads to increased sorbitol and water influx. The osmotic changes in the lens are not immediately corrected when the glucose concentration in aqueous humor is lowered, and this can lead to obstruction of the canal of Schlemm and increased intraocular pressure. 

Blake DR, Nathan DM. Acute angle closure glaucoma following rapid correction of hyperglycemia. Diabetes Care 2003 26 3197-8. 

A small number of cases of acute angle-closure glaucoma have been reported in patients treated with a combination of nebulised salbutamol and ipratropium bromide, caused possibly by local absorption of mist containing both products. A combination of nebulised salbutamol with nebulised anticholinergics should therefore be used cautiously. Patients should receive adequate instruction in correct administration and be warned not to let the solution or mist enter the eyes. Use of a mouthpiece rather than a mask for administration would reduce the risk associated with this. 

Additional noncoagulating thromboxane agonist derivatives were prepared by the authors (1) in an earlier investigation. [15 -[la,2a-(Z),3P-(l , 3S, ) ta]]-7-[3-(3-hydroxy)-4-(4-iodophenoxy)-1 -butenyl]-7-oxabicyclo[2.2. l]hept-2-yl]-5-hepten-l -ol, (II), is especially preferred for treating acute angle-closure glaucoma. 

Lewis CF, DeQuardo JR, DuBose C, Tandon R. Acute angle-closure glaucoma and paroxetine. J Clin Psychiatry 1997 58(3) 123-4. 

Kirwan JF, Subak-Sharpe I, Teimory M. Bilateral acute angle closure glaucoma after administration of paroxetine. Br J Ophthalmol 1997 81(3) 252. 

Tricyclic antidepressants predispose to acute angle closure glaucoma, probably through an anticholinergic action. However, acute angle closure has also been reported with SSRIs, suggesting that all serotonin-... 

Acute angle closure glaucoma has been reported in a 45-year-old woman taking venlafaxine (75 mg/day) and chlorpromazine (150 mg/day) (15). She had previously taken low-dose dosulepin (75 mg/day), chlorpromazine, and SSRIs without ophthalmic problems. 

Ng B, Sanbrook GM, Malouf AJ, Agarwal SA. Venlafaxine and bilateral acute angle closure glaucoma. Med J Aust 2002 176(5) 241. 

IPRATROPIUM BRONCHODILATORS -SALBUTAMOL A few reports of acute angle closure glaucoma when nebulized ipratropium and salbutamol were coadministered Ipratropium dilates the pupil, which i drainage of aqueous humour, while salbutamol t production of aqueous humour Warn patients to prevent the solution to mist or enter the eye. Extreme caution in co-administering these bronchodilators by the nebulized route in patients with a history of acute closed-angle glaucoma... 

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