Management of Acute Angle-Closure Glaucoma
1. Emergency referral
Urgent ophthalmology referral / admit if needed.
2. Assess first
Visual acuity + IOP + slit-lamp exam.
3. Lower IOP immediately
Topical treatment:
Timolol eye drops
Brimonidine eye drops
Dorzolamide eye drops
Systemic treatment:
Acetazolamide oral/IV
Mannitol IV if IOP very high or not responding
4. Pain and vomiting control
Analgesic
Antiemetic
5. Pilocarpine
Give pilocarpine after IOP starts to fall, not immediately if IOP is very high.
6. Definitive treatment
Laser peripheral iridotomy “LPI”
7. Treat the other eye
Prophylactic laser peripheral iridotomy for the fellow eye because it is at risk.
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