Glaucoma
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Introduction
Can have tremendously variable and confusing presentation; it should be on the differential for anyone with a red eye or
The Case of...
a simple case introducing clincial presentation and calling for a differential diagnosis to get students thinking.
Causes and Risk Factors
Medications, changes in light
Most common in middle-aged or seniors who are far-sighted.
Pupillary dilation
Pathophysiology
Acute glaucoma is associated with increased intraocular pressure following obstruction of the outflow of aqueous humor. This is most often due to a narrowed anterior chamber.
a narrowing
Optic neuropathy due to . Canals of schlemm
Signs and Symptoms
- history
- physical exam
History
Acute glaucoma can cause severe headache, characterized by throbbing.
vision changes, often with halo
nausea and vomiting
Physical Exam
injected, classically in a peri-limbic pattern
hazy cornea
fixed, dilated pupil
gentle palpation reveals hard eye
Investigations
Measure intraocular pressure (normal is less than 20-30)
Differential Diagnosis
Treatments
Pilocarpine, a miotic drop, can be used to constrict the pupil and relieve pressure by allowing aqueous outflow.
Other treatments include:
- acetazolamide
- topical beta-blocker
- topical steroid
- analgesics
- antiemetics
- consult ophthalmologist
Consequences and Course
Resources and References
Topic Development
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