There are 2 types of glaucoma:
- acute = closed angle glaucoma
- chronic = open angle glaucoma
Acute closed angle glaucoma
Acute closed angle glaucoma presents as:
- pain
- decreased visual acuity
- worsening of pain with mydriasis
- hard, red eye
- halos around lights
- semi-dilated, non-reactive pupil
- pt systemically unwell
Risk factors for closed angle glaucoma include hypermetropia and pupillary dilation.
Management is:
- urgent opthalmic review
- IV acetazolamide (a carbonic anhydrase inhibitor; decreases aqueous secretions)
- topical pilocarpine (constricts pupil)
Open angle glaucoma
This affects 2% of over 40s.
Risk factors include:
- family history
- black
- myopia
- hypertension
- diabetes
Features include:
- peripheral field loss
- decreased visual acuity
- optic disc cupping
Treatments include:
- eye drops (beta blockers or prostaglandins)
- possibly surgery.
Now to our final battle of the day, autonomic neuropathy
