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Glaucoma

Differential Diagnosis for Red Eye
Conjunctivitis Acute Iritis Acute Angle
Closure Gloucoma
Keratitis
Discharge Bacteria: pus
Virus: serous

no no Profuse tearing
Pain no ++ (globe) +++(nauseating) ++(on blinking)
Photophobia no +++ + ++
Blurred vision no ++ +++ varies
Pupil normal smaller Fixed in mid-
dilation
Same/smaller
Cornea normal Keratatic
precipitate
cloudy Infiltrate, edema
Intraocular
pressure
normal varies Increased
markedly
Normal or
increased
Others Large Posterior
synechiae
Colored halos
nausea &
vomiting
pale, cupped optic disc
Signs (Fig. 9.19)
 Lids may be oedematous,
 Conjunctiva is chemosed, and congested, (both conjunctival and ciliary
vessels are congested),
 Cornea becomes oedematous and insensitive,
 Anterior chamber is very shallow. Aqueous flare or cells may be seen in
anterior chamber Angle of anterior chamber is completely closed as seen
on gonioscopy (shaffer grade 0),
 Iris may be discoloured,
 Pupil is semidilated, vertically oval and fixed. It is non-reactive to both
light and accommodation,
 IOP is markedly elevated, usually between 40 and 70 mm of Hg,
 Optic disc is oedematous and hyperaemic,
 Fellow eye shows shallow anterior chamber and a narrow angle (latent angle
closure glaucoma).
Circumcorneal injection
about 4 mm from the cornea
the anterior ciliary
vessels perforate the sclera
to supply the ciliary body.
They therefore dilate as
the result of any congestion
of the anterior segment.
Comeal oedema
the corneal endothelium has a metabolic pump
mechanism which pumps water out of the corneal
stroma into the aqueous.
≥ 40mmhg : pump cannot cope and water fails
to pass out of the cornea
Dilated pupil
closure of the angle of the anterior chamber is the cause of the
acute attack, this may be precipitated by dilatation of the pupil. In
turn the acute pressure rise causes paralysis of the iris muscles so
that the pupil remains fixed in semi-dilatation
Optic atrophy and permanent visual loss
optic nerve head as the intraocular pressure rises
above capillary and arteriolar pressure, causing at
first congestion and later a failure of perfusion of
vessels supplying the nerve.
Management
• Administered Acetazolamide
intravenously and orally, together with
topical pilocarpine and beta-blockers.

• Subsequently, laser peripheral
iridotomy is done.