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| Acute congestive glaucoma |
Acute congestive glaucoma
An attack of acute primary angle closure glaucoma occurs due to a sudden total angle closure leading to severe rise in IOP.Clinical features
Symptoms
- pain: sudden önset of very severe pain
- nausea, vomiting and prostrations
- redness, photophobia and lacrimation with progresv impairment of vision
- past history: previous attcks of same
Signs
- lids may b oedematous
- conjunctiva is chemosed and cyanosed
- cornea bcomes insensitive and oedmatous.
- angle of anterior chamber closd
- iris may b discoloured
- pupil is semidilated, verticly oval, fixed.
- IOP is raised.
- optic disc oedematous and hypermic
Management
A. Medical therapy
1. Systemic hyperosmotic agent intravemous mannitol
2. Acetozolamide 500mg i.v. Inj followd by 250 mg tab thrice a day
3. Analgesics and antiemetics
4. Pilocarpine eyedrops
5. Beta blocker eyedrops like 0.5 timolol maleate
6. Corticosteroid eyedrops like dexamethasone and betamethasone
B. Surgical therapy
1. Peripheral iridotomy- it is indicated when the peripheral ant synechiae are formed in less than 50% of ant chamber and as prophylaxis in other eye.
2. Filtration surgery- when IOP is not controlled wid the best medical therapy folwnp an attack of angle closure glaucoma and also when peripheral ant synechiae is formed inp more than 50% of angle of ant. Chamber.
3. Clear lens extractn by phacoemulsifictn with intraocular lens implantation
C. Prophylaxis treatment in normal fellow eye
Prophylactic laser iridotomy or surgical peripheral iridectomy should be performed on the fellow asymptomatic eye..
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