Question

Acute angle closure glaucoma first line treatment?

• A. IV mannitol
• B. Acetazolamide
• C. Pilocarpine
• D. Beta blocker eyedrops

Hint:

You need the fastest pressure-lowering agent first, an IV osmotic.

Answer 1

The Correct Option is A

Step 1: Acute angle closure glaucoma is an emergency with a very high intraocular pressure. The first aim is to bring the pressure down rapidly with systemic osmotic and pressure-lowering agents.

Step 2: The initial step is to start intravenous mannitol (an osmotic agent that pulls fluid out of the eye) or intravenous acetazolamide to reduce aqueous production. IV mannitol acts fastest in lowering the pressure.

Step 3: Once the pressure starts falling, topical pilocarpine and a beta blocker such as timolol are added; apraclonidine or latanoprost may also be used. These topical drugs work poorly at very high pressure because the ischaemic iris sphincter cannot respond, so they are not the first agent.

Step 4: Definitive treatment is laser Nd:YAG peripheral iridotomy after the pressure is controlled. Among the listed options the first line emergency drug is IV mannitol.