What is it?
It is a type of glaucoma in which the anatomy of the iridocorneal angle is altered. There is a sudden closure of the iridocorneal angle that prevents the drainage of aqueous humor. This causes a sudden and exaggerated rise in intraocular pressure that does not resolve spontaneously.
Acute glaucoma represents a true ophthalmological emergency, so it is necessary for the patient to contact their ophthalmologist immediately.
Symptoms
Symptoms and signs are directly related to elevated intraocular pressure.
· Signs:
o Elevated intraocular pressure, usually ≥ 45 mm Hg.
o Sudden decrease in visual acuity.
o Congestive-looking eye (red and inflamed).
o Pupil in middle mydriasis (medium dilation) that does not react to light stimuli.
o Corneal edema (clouding of the cornea).
o Shallow or even flat anterior chamber.
· Symptoms:
o Blurred vision.
o Vision of colored halos around the lights (consequence of corneal edema).
o Very severe eye pain.
o Headaches.
o Nausea and / or vomiting.
Some people may have what is called an “occludable angle,” leading to intermittent angle-closure glaucoma. This can generate similar symptoms, but much milder than acute glaucoma. The main difference is that intermittent glaucoma resolves spontaneously.
Prognosis
Acute glaucoma is an ophthalmological emergency and, if it is not treated properly (in a timely manner), its prognosis is poor (blindness).
Treatment
Treatment can be medical, laser, or surgical.
· Medical treatment:
o It represents the first-choice therapy.
o The first step is to reduce intraocular pressure, for this, topical medication (eye drops) may not be enough, so in many cases it is necessary to administer systemic medication (pills) and even intravenous medication (intravenous diuretics).
o Administration of anti-inflammatory eye drops (steroidal or non-steroidal) to reduce inflammation.
o Symptomatic systemic treatment for headaches, nausea and / or vomiting.
· Laser:
o Treatment consists in performing a peripheral iridotomy. It consists of creating a small hole in the iris, which allows communication between the anterior segment and the posterior segment, which facilitates the drainage of aqueous humor. It is considered as the definitive treatment for this type of problem. However, before doing it, it is necessary to reduce intraocular pressure and ocular inflammation.
· Surgery:
o In some cases, it may be necessary to perform surgery in the operating room.
o Iridectomy: It is normal to perform a laser iridotomy, but in some cases this is not possible, so a surgical iridectomy is performed.
o Lens extraction: If acute glaucoma is caused by pupillary blockage secondary to the lens (for example, trauma can cause the lens to dislodge into the anterior chamber). In these cases, the lens may need to be removed by surgery.
