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08/05/2018

Acute Angle Closure


Glaucoma

Treatment of Acute Angle


Closure Glaucoma • Sudden IOP elevation
dr. Ardiella Yunard, SpM • Closed angle
• Classic signs and symptoms

CORNEA
Current Updates Of Ophthalmologic Disorders And
Managements For Physicians And Medical
Students

Angle Closure
Symptoms
Mechanism

Blurring of Severe eye


Red eye
vision pain

Ipsilateral Nausea and Colored


headache vomitting Haloes
08/05/2018

How to Manage
Signs
APAC?
Corneal
Elevated IOP
Ciliary and edema Treatment
conjunctival
injection • Eliminate block pupil
Middilated Decreased History • Reduce IOP
pupil
visual acuity

Mild AC Examination
Shallow inflammation
anterior
chamber

Reducing IOP (1/3) Reducing IOP (2/3)


• Carbonic anhydrase inhibitors : Acetazolamide oral • Osmotic agents
• Dose of 500 mg, then 3-4 x 250 mg • Intravenous mannitol 20%
• Maximum IOP reduction is reached in 2-4 hours and • 2.5-7 ml/KgBW, 60 drops per minute
lasts for 6-8 hours • Oral glycerin 50%
• Add KCl 2x 300 mg • 1.5-3 ml/KgBW
• Avoid in diabetics
• Monitor systemic conditions
08/05/2018

Eliminating Block
Reducing IOP (3/3)
Pupil
Topical antiglaucoma • Miotics (e.g., pilocarpine 2%)
• Beta blockers • Break an early angle-closure attack, ineffective if the
• Selective alpha agonists iris is already ischemic
• Avoid High-concentration miotics (e.g., pilocarpine
• Carbonic anhydrase inhibitors 4%) : forward displacement iris-lens diaphragm
• Prostaglandin analogues – unreliable effect in acute attack • Definitive treatment refer to ophthalmologist
because of slow onset of action • Laser iridotomy
• Reduce Inflammation: topical steroids • Cataract extraction: phaco

Laser Peripheral
Iridotomy

THANKYOU !

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