| ID | 265 |
|---|---|
| Name | ACUTE CONGESTIVE GLAUCOMA |
| Cause | |
| Signs Symptoms | |
| Diagnosis | Diagnostic criteria of closed angle glaucoma in early stage: 1. Attack sudden, transient, blurring of vision with rainbow hallow around the light in elderly person. 2. Narrowed angle of the anterior chamber revealed by gonioscopy. 3. Positive provocative tests (dark room test and mydriatic test). Stages of A.C.G: 1. Prodromal stage. 2. Stage of constant instability. 3. Acute congestive stage. J 4. Chronic congestive stage. 5. Stage of absolute glaucoma. |
| Investigations | Investigations: 1. Tonometry 2. Goneoscopy 3. Perimetry and scotometry 4. Tests with mydriatics 5. Dark room test 6. Fundoscopy |
| Management | |
| Introduction | In this case, the intraocular pressure is raised as a result of obstruction to the outflow of the aqueous due to extreme narrowness of the angle of the anterior chamber. |
| History | |
| Etiology | |
| Clinical Features | Clinical features: Symptoms: 1. Initially there is blurring of vision and mild headache. 2. But in acute attack, there is intense pain, severe headache & marked dimness of vision. 3. Photophobia & lacrimation. 4. Oedema of the lids. Signs: 5. Congestion of the conjunctiva. 6. Chemosis of the conjunctiva. 7. Cornea may be insensitive. 8. Anterior chamber is very shallow. 9. Pupil is moderately dilated, vertically oval, non-reactive to light. 10. Iris is discoloured. 11. Itra-ocular pressure is markedly raised & eye ball is very tender. There is associated systemic disturbances such as vomiting, rise of body temperature etc. 12. In absolute glaucoma- eye is completely blind, cornea is hazy, iris is atrophic, optic disc is deeply cupped the tension is very high, later on cornea becomes ulcerated & eye may shrink as a result of pressure atrophy. |
| Preventions | |
| Treatment | Treatment: A. Medical: 1. The patient must be hospitalized. 2. Treatment to lower the intraocular pressure- i. Miotics like pilocarpine nitrate 2% or eserine sulph 0.5-1% 3 times } daily. ii. Acetazolamide 250mg tablets orally 4 times daily, iii. Timolol 0.5% eye drop 1 drop twice daily. 3. Treatment for relief of pain-pethidine l00mg i.m. 4. For relief of congestion- hydrocortisone acetate 1% drop evry hourly. B. Surgical: 1. If the tension is not controlled within 24 hours by medical treatment then a surgical operation has to be performed as follows-i. basal iridectomy. ii. iridencleisis operation. 2. If congestion and tension subside with medical treatment, it is better to wait until the eye becomes completely quiet. If there is no peripheral anterior synechie, a peripheral button-hole iridectomy at 12 0’clock position should be done. But if peripheral anterior synechie have already formed, iridectomy dialysis or iridencleisis operation has to be done. 3. In absolute glaucoma- enucleation operation is advisable if the pain is f f troublesome. |
| Complications | |
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