In acute angle-closure glaucoma the iris blocks the drainage angle of the eye, so the pressure inside the eye rises quickly. It is an eye emergency that can cause permanent vision loss within hours if not treated.
Key symptoms
- Sudden severe eye pain and headache
- Blurred vision and halos around lights
- Nausea and vomiting
- Red eye, often starting in dim light or after dilating drops
What you find on exam
- Red eye with redness around the cornea
- Mid-dilated pupil that reacts poorly to light
- Hazy, cloudy cornea
- Eye feels hard to gentle touch; reduced visual acuity
Tests
- Tonometry: very high eye pressure, often above 40 mmHg
- Slit lamp: shallow anterior chamber
- Gonioscopy by ophthalmology to confirm a closed angle
- Check the other eye, which is also at risk
Treatment basics
- Urgent same-day ophthalmology referral
- Topical timolol, apraclonidine and pilocarpine
- Acetazolamide by mouth or IV; IV mannitol if pressure stays very high
- Laser peripheral iridotomy as definitive treatment, usually in both eyes
- Treat pain and vomiting; avoid dilating drugs
Red flags
- Fast loss of vision
- Pressure that does not fall with medical treatment
- Symptoms starting in the other eye
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.