A 55 years lady presented with sudden onset of severe pain in the eye with, Shallow anterior chamber. Treatment of choice is
(1/V mannitol & Acetazolamide): (242-Nema 6th edition; 244-Khurana 5th/e)It is a case of Acute primary angle closure glaucomaImmediate medical therapy to lower IOP1. Systemic hyper osmotic agents* Intravenous mannitol (1 gm 1 kg body weight)* Oral hyperosmotics eg glycerol2. Systemic carbonic anhydrase inhibitor eg acetazolamide3. Topical antiglaucoma drugs -* Beta blocker - 0.5% timolol or 0.5% betaxolol* Alpha adrenergic agonist eg. brimonidine - 0.1 - 0.2%* Prostaglandin analogue eg - latanoprost - 0.005%Intensive miotopic (Pilocarpine 2%) therapy is not advised now a day4. Analgesics and anti-emetics5. Compressive gonioscopy6. Topical steroid eg - prednisolone acetate 1% or dexamethasone* Laser iridotomy is the treatment of choice for the management of early acute PACG* *** Prophylactic laser iridotomy should be performed on the fellow asymptomatic eye as early as possible as chances of acute attack are 50% in such cases
Atropine
I/V mannitol & Acetazolamide
Atenolol
Steroids I/V
Glaucoma