Acute narrow-angle (closure)
• Less than 10% of glaucoma
• Risks - farsighted, elderly (>60's), female, diabetes
• Pupillary dilation narrows angle of anterior chamber blocking outflow of humor
• Dilation caused by dim light, stress, anticholinergic/sympathomimetic medications
• Shallow anterior chamber, steamy cornea (edema), pupil mid-dilated and non-reactive
• Cloudy vision, eye pain, h/a, N/V, occasionally abdominal pain
• Elevated IOP (>30 mmHg)
Tx
• Acetazolamide 500 mg IV followed by 500 mg PO
• Topical BB (inhibits humor production - timolol)
• Topical alpha blocker
• Pilocarpine (shrinks pupil) – does not work if
pressure over 40mmHg - start using 1 hour after beginning treatment
every 15 minutes for 2 doses
• Mannitol
• Peripheral laser iridectomy
Open-angle
• Most common form of glaucoma (70-80%)
• Risks - near-sighted, age, AA, FHx, DM
• Angle is open but flow is inhibited
• Gradual onset, painless, visual field loss at periphery that moves centrally
• Topical BB or alpha-agonitst
Aqueous humor made by the ciliary body in the posterior chamber flows
through the angle of the pupillary aperture into the anterior chamber
where it leaves the eye through the trabecular meshwork where it passes
into the canal of Schlemm which drains into episcleral veins