NAME: BASIRIKA MARY CAROLYNE

REG No: 19/U/18906/PS

STUDENT NUMBER: 1900718906

CASE 1

Acute closed angle glaucoma in view of the rapid impairment of vision, hazy
cornea, acute onset of nausea and vomiting, headache

On History, I would try to determine whether the suspected glaucoma was either
primary or secondary by looking for presence of conditions uveitis (hx-
photophobia, red eyes, and lacrimation. Ask for any history of eye trauma, cataract
surgery

On Examination- The ciliary body would appear dilated, the cornea hazy, the
anterior chamber shallow and the pupil semi- dilated, non-reactive and slightly
irregular

I would confirm closed angle glaucoma by measure IOP using tonometry, do

gonioscopy to assess degree of angle closure, checking visual fields using
perimetry and check for glaucomatous cupping on fundoscopy.

In the Management, I would manage the IOP in order to prevent further visual
loss (IV acetazolamide, IO timolol), give analgesia for pain management and anti-
emetics for nausea. In case there is no relief of symptoms with acetazolamide use, I
would recommend iridectomy to relieve the angle closure.
 CASE 2

Central retinal artery occlusion in view of the sudden loss of vision, cherry red spot
on the macula, a white opacified retina and a loss of a direct pupillary reflex in the
affected eye.

Treatment includes;
1. Immediate lowering of intraocular pressure by intravenous mannitol and
intermittent ocular massage to aid the arterial perfusion and also help in dislodging
the embolus. Even paracentesis of anterior chamber.
2. Vasodilators and inhalation of a mixture of 5percent carbon dioxide and 95
percent oxygen (practically patient should be asked to breathe in a polythene bag)
may help by relieving element of angiospasm.
3. Anticoagulants like recombinant tissue plasminogen activator.
4. IV methylprednisolone to reduce the retinal edema.