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Home > REBEL Cast > REBEL Core Cast 19.0 – Acute Angle Closure Glaucoma


	Podcast:		REBEL Cast
	Episode:		REBEL Core Cast 19.0 – Acute Angle Closure Glaucoma
	Category:		Science & Medicine
	Duration:		00:09:58
	Publish Date:		2019-10-09 09:00:22
	Description:		Take Home Points Acute closed angle glaucoma is an ophthalmologic emergency that usually presents with sudden, painful, monocular vision loss. Physical exam will reveal conjunctival redness, corneal haziness or cloudiness due to edema and a pupil that is mid sized and minimally reactive to light, a rock hard globe and IOP >/= 21. These patients require emergent ophthalmology evaluation but treatment should be started empirically while waiting for the evaluation. Initial treatment to decrease IOP usually includes a topical BB such as timolol and topical AB such as apraclonidine and either IV or PO acetazolamide. REBEL Core Cast 19.0 – Acute Angle Closure Glaucoma Click here for Direct Download of Podcast Show Notes What is it? Group of diseases that have increased intraocular pressure (IOP) causing optic nerve damage leading to decreased vision Different types of glaucoma Open-angle glaucoma Closed-angle glaucoma Open-Angle Glaucoma Most common type Characteristized by progressive peripheral visual field loss followed by central Likely because of increased resistance to aqueous outflow through trabecular meshwork Patients generally have increased IOP Closed-Angle Glaucoma Worrisome pathology in the emergency department Closing / Narrowing of the anterior chamber angle Increased aqueous humor collection leads to increased IOP and damage to the optic nerve Presents with sudden painful vision loss, red eye, halos, frontal or supraorbital headache Differential for Painful Red Eye Corneal abrasion Conjunctivitis Subconjunctival hemorrhage Iritis Episcleritis Infectious keratitis Traumatic hyphema Risk Factors for Glaucoma Family history Age >60 years Female Gender Far sighted Medications (HCTZ, albuterol, SSRI, TMP-SMX among others) Inuit & Asian ethnicity Eye Exam Any person presenting with vision loss or eye pain deserves full exam Visual acuity Pupil exam Visual field testing Evaluation of IOP with a tono-pen Slit-lamp exam Fundoscopy Physical Exam Conjunctival redness Corneal haziness Mid sized pupil minimally reactive to light Palpate eye – potentially “rock hard” Always use the tono-pen , >20 IOP Treatment Consult ophthalmology Topical beta blocker – timolol Topical alpha blocker – Apraclonidine 500 mg IV / PO acetazolamide Recheck IOP hourly, keep head of bed elevated, keep in bright room For More on This Topic Checkout: Core EM: Non-Traumatic Monocular Vision Loss WikEM: Acute angle-closure glaucoma WikEM: Tono-Pen Use Shownotes Written By: Miguel Reyes, MD (Twitter: @miguel_reyesMD) Post Peer Reviewed By: Salim R. Rezaie, MD (Twitter: @srrezaie) The post REBEL Core Cast 19.0 – Acute Angle Closure Glaucoma appeared first on REBEL EM - Emergency Medicine Blog.
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