Review Question - QID 107584

Acute angle closure glaucoma, also known as narrow angle glaucoma, presents with sudden onset blurry vision, hardened eyeball and increased IOP. First line emergency treatment includes alpha 2 selective adrenergic agonists, beta blockers, or carbonic anhydrase inhibitors.

Acute angle closure glaucoma is caused by relative pupillary block of aqueous humor as it flows from the posterior to anterior chamber through the iris-lens channel (the canal of Schlemm). Sudden attacks are more likely to occur when the pupil is partially dilated, for example, being in a darkened room such as a movie theater, or when eye drops are taken that dilate the pupil. If not treated immediately, it can damage the optic nerve and result in permanent vision loss within hours. Risk factors include certain medications (dilating drops, anticholinergic, antidepressants).

Incorrect Answers:
Answer 2: Epinephrine would cause pupil dilation which would worsen acute angle glaucoma.
Answer 3: Laser peripheral iridotomy is appropriate and definitive treatment for acute angle glaucoma in the post-acute phase of treatment once IOP is controlled.
Answer 4: Anti-cholinergics would cause pupil dilation which would worsen acute angle glaucoma
Answer 5: NSAID ophthalmic solution can theoretically worsen acute angle glaucoma because of its anti-prostaglandin effect.