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What is Acute angle closure glaucoma first line treatment? and explain in detail?
Ans. is 'a' i.e., I.V. Mannitol Treatment of angle closure glaucoma Definitive treatment (treatment of choice) is surgery. However, intially drugs are used to decrease KW during an acute attack. Approach of treatment is as follows:- Sta i.v. mannitol or i.v. acetazolamide When IOT stas falling, sta topical pilocarpine or b-blocker (timolol). Apraclonidine/latanoprost may be added. Once IOT is reduced, surgery is done. Topical pilocarpine 2% is the preferred antiglaucomatous drug. After control of IOP, Laser (Nd : YAG) peripheral irodotomy is the definitive management of choice. If laser is not available surgical peripheral iridectomy is the procedure of choice. Other surgical procedures used are filteration surgeries (like trabeculectomy, deep sclerotomy, Viscoanulostomy). Symptomatic treatment during an attack also includes analgesics, antiemetic and topical coicosteroids to reduce inflammation. Mydriatics (e.g. atropine) are contraindicated as they precipitate glaucoma. PACG is a bilateral disease, the fellow eye is at risk of developing an acute attack in 50% cases in future. Therefore a prophylactic peripheral laser iridotomy should be performed in the fellow eye.