A red, painful eye with a mid-dilated pupil, corneal haze, halos and vomiting may be acute angle closure, and is sometimes first seen by a physician as a headache or abdominal complaint. Pressure can be very high, and the optic nerve is at risk within hours.
The aim is to lower pressure medically, then break the pupil block with laser or surgical iridotomy, and assess the fellow eye, which is often at risk too.
- Start topical pressure-lowering drops and systemic acetazolamide unless contraindicated.
- Check for sulfonamide allergy, renal impairment and sickle cell disease before acetazolamide.
- Give pilocarpine once pressure starts to fall, as the ischaemic iris responds poorly at very high pressure.
- Plan iridotomy for the affected eye and assess the fellow eye's angle.
Why it matters
Hours of delay can mean permanent visual loss.
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