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Acute Glaucoma
Acute glaucoma is an eye condition, where the pressure inside the eye rises
quickly. The usual symptoms are sudden eye pain, a red eye and reduced
vision. Other possible symptoms are headache, abdominal pain, nausea and
vomiting. Acute glaucoma can be treated successfully, but it needs
immediate treatment to relieve symptoms and to prevent damage to the eye.
Note: acute glaucoma is also called 'acute angle closure glaucoma' or 'acute closed angle
glaucoma'. Another term sometimes used is 'primary angle closure glaucoma', which is a
similar situation that can lead to acute glaucoma.
There are other types of glaucoma, which occur more gradually. The most common type is
'primary open angle glaucoma' (also called 'chronic glaucoma'). There is a separate leaflet
on chronic glaucoma. Other, less common types are 'secondary glaucoma' and 'congenital
glaucoma'. The rest of this leaflet deals only with acute glaucoma.
The iris (coloured part of the eye) is also involved. The iris muscle is responsible for
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controlling the size of the pupil (the black area in the middle of the eye). When the iris
muscles enlarge the pupil, they tend to bulge, which can block the flow of fluid if the area is
already narrow. The pupil enlarges in conditions of dim light, sudden excitement, or with
certain medications. For this reason, acute glaucoma is more likely to occur in the evening,
or in situations like watching a football match on TV (dim lighting and sudden excitement).
What can trigger acute glaucoma?
Various medications can trigger acute glaucoma if you are susceptible to it. However, for
the population as a whole, the chance of getting acute glaucoma with these medicines is
very small - so they are commonly prescribed without too much worry. But if you have been
warned that you may be susceptible to acute glaucoma, tell your doctor before starting new
medication or eye drops, especially if it is one of the ones listed below.
Lying on your front (for a long period) may also affect fluids in the eye, and can trigger acute
glaucoma. This can occur, for example, during an operation on the spine.
As explained above, symptoms often begin in a situation of dim lighting, sudden excitement,
with certain medications or after a general anaesthetic.
Are there any warning symptoms?
Acute glaucoma can start 'out of the blue' with no warning. However, you may have warning
symptoms, which often are not recognised. These occur when pressure rises in the eye,
and then improves by itself. The symptoms are: blurred vision, seeing haloes or rainbows
around lights, and eye pain. The warning symptoms can come and go - they may start in the
evening (with dim light), and may settle after sleep (because sleep relaxes the iris muscles).
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If you have these symptoms you should see a doctor urgently, in case you need treatment
to prevent a more severe attack.
The first treatment is medication to lower the pressure of fluid in the eye. There are various
types of medicine that reduce eye pressure. Different combinations can be used, depending
on your medical history. The usual treatment is:
An intravenous injection of acetazolamide.
Eye drops containing beta-blocker medication (to reduce fluid in the eye) and steroid
(to reduce inflammation).
Further treatment
When the pressure in the eye has gone down, further treatment is needed in order to
prevent the acute glaucoma from coming back. This involves using laser treatment or
surgery to make a small hole in the iris. The hole allows fluid to flow freely around the iris,
which stops the iris bulging forwards and blocking the trabecular meshwork.
Laser treatment is called 'peripheral iridotomy'. This is the usual treatment, and the
preferred option, as it does not involve surgery to the eye. Two small holes are made in the
iris using a laser. The holes are almost unnoticeable to other people.
Surgical treatment is called surgical iridectomy. It makes a small, triangular hole in the iris.
The hole is visible afterwards as a very small, black triangle at the edge of the iris.
Sometimes, another type of surgery is used, which is similar to a cataract operation. This
operation removes the lens of the eye - which can help if a swollen lens was causing the
acute glaucoma in the first place. As with cataract operations, the lens which is removed
can be replaced by an artificial lens, or by using glasses.
Usually, laser or surgical treatment will be advised for the other eye at some stage. This is
to prevent acute glaucoma happening in the other eye. Also, eye drops may sometimes be
needed as long-term treatment, to help keep the eye pressure under control.
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Also, delayed treatment can lead to the the iris (coloured part of the eye) sticking to the front
of the eye (cornea). This blocks the drainage area, so a 'drainage operation' is needed. This
operation creates a channel between the inside of the eye and the outside (white part) of
the eye.
If you are at very high risk of acute glaucoma, you may be advised to have treatment such
as laser iridotomy (above) to prevent it.
Be aware of the symptoms of acute glaucoma. Anyone who has a red eye with pain or
vomiting, or a red eye with reduced vision, should get medical advice immediately. If you
take a new medication or have eye drops to dilate the pupil, and then have symptoms of
acute glaucoma, get medical advice straightaway; tell the doctor about the medication and
symptoms. This makes it easier for the problem to be recognised early.
References
Darkeh AK; Glaucoma. Acute angle closure; eMedicine. May 2006
Chua CN; Eye casualty: common ocular emergencies and referrals.
Khaw PT, Shah P, Elkington AR; Glaucoma--1: diagnosis. BMJ. 2004 Jan 10;328
(7431):97-9.
Saw SM, Gazzard G, Friedman DS; Interventions for angle-closure glaucoma: an
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© EMIS and PiP 2008 Updated: 25 Jul 2008 DocID: 9002 Version: 1