Understanding Acute Angle Closure Glaucoma

Summary

In this educational video, Tom from zero2finals.com discusses acute angle closure glaucoma, an eye emergency characterized by a sudden rise in intraocular pressure due to aqueous humor blockage. He outlines risk factors, including age, gender, ethnicity, and certain medications. Symptoms include severe eye pain, redness, and vision impairment. Immediate treatment is crucial to prevent vision loss. Tom explains emergency measures like pilocarpine eye drops and oral acetazolamide, and the definitive laser iridotomy treatment. The video is a valuable resource for understanding this critical condition.

Takeaways

• 👀 Glaucoma is an optic nerve damage caused by a significant rise in intraocular pressure due to a blockage in the aqueous humor.
• 🔍 Acute angle closure glaucoma occurs when the iris bulges forward, sealing off the trabecular meshwork and preventing aqueous humor drainage.
• 🚨 It is an ophthalmology emergency requiring immediate treatment to prevent permanent vision loss.
• 👁️ Risk factors for acute angle closure glaucoma include increasing age, female gender, family history, Chinese or East Asian ethnicity, and a shallow anterior chamber.
• 💊 Certain medications like adrenergic agents, anticholinergic drugs, and tricyclic antidepressants can trigger this condition.
• 🤢 Patients typically present with severe eye pain, redness, blurred vision, halos around lights, headache, nausea, and vomiting.
• 🔎 Examination may reveal a red, teary eye, hazy cornea, decreased visual acuity, a dilated and non-responsive pupil, and a firm eyeball on palpation.
• 🏥 Immediate management includes referral to an ophthalmologist, lying the patient flat without a pillow, and administering specific eye drops and medications if available.
• 💧 Pilocarpine eye drops work by constricting the pupil and opening the angle for better aqueous humor drainage.
• 💊 Acetazolamide reduces aqueous humor production by inhibiting carbonic anhydrase.
• 🏥 Secondary care management involves medical options like pilocarpine, acetazolamide, hyperosmotic agents, beta blockers, and carbonic anhydrase inhibitors to reduce pressure.
• 🔑 Definitive treatment is laser iridotomy, a procedure to create a hole in the iris for improved aqueous humor flow and pressure relief.

Q & A

What is glaucoma and what causes it?

Glaucoma refers to optic nerve damage caused by a significant rise in intraocular pressure due to a blockage in the aqueous humor trying to escape from the eye.

What is acute angle closure glaucoma?

Acute angle closure glaucoma occurs when the iris bulges forward and seals off the trabecular meshwork, preventing aqueous humor from draining away and leading to a continual buildup of pressure in the eye.

Why is acute angle closure glaucoma considered an ophthalmology emergency?

It is considered an emergency because it requires immediate treatment to prevent permanent loss of vision due to the rapid increase in intraocular pressure.

What are the risk factors for developing acute angle closure glaucoma?

Risk factors include increasing age, being female, having a family history of angle closure glaucoma, being of Chinese or East Asian ethnic origin, and having a shallow anterior chamber.

How does acute angle closure glaucoma differ in prevalence among different ethnic groups compared to open angle glaucoma?

Acute angle closure glaucoma is more common in people of Chinese or East Asian origin, whereas open angle glaucoma is more common in people of black ethnic origin.

What medications can precipitate acute angle closure glaucoma?

Certain medications such as adrenergic medications like neuroadrenaline, anticholinergic medications like oxybutynin and solifenacin, and tricyclic antidepressants like amitriptyline can precipitate acute angle closure glaucoma.

What are the typical symptoms of acute angle closure glaucoma?

Patients may experience a severely painful red eye, blurred vision, halos around lights, headache, nausea, and vomiting.

What signs might be observed during an examination of a patient with acute angle closure glaucoma?

Signs include a red and teary eye, a hazy cornea, decreased visual acuity, a dilated and fixed pupil, and a firm and hard eyeball on palpation.

What is the initial management for a patient with acute angle closure glaucoma?

Initial management includes referring the patient for same-day assessment by an ophthalmologist, lying the patient on their back without a pillow, administering pilocarpine eye drops, acetazolamide orally if available, and providing analgesia and antiemetics.

How does pilocarpine help in the treatment of acute angle closure glaucoma?

Pilocarpine acts on the muscarinic receptors in the iris, causing constriction of the pupil and ciliary muscle contraction, which helps to open up the angle and allow better drainage of the aqueous humor.

What is the definitive treatment for acute angle closure glaucoma?

The definitive treatment is laser iridotomy, a surgical procedure that uses a laser to make a hole in the iris, allowing aqueous humor to flow from the posterior chamber into the anterior chamber and relieving pressure.