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青光眼為不可逆性失明 (白內障為可逆失明)
正常人眼內壓 : 11-21 mg
早上眼壓高
隅角開放型 : 小樑組織老化, 房水回收差
高度近視者較多, 症狀不明顯, 視力模糊最晚出現
隅角閉鎖型 : 隅角較窄
東方人, 前房較淺, 遠視眼
- Acute onset ocular pain with nausea vomiting
- Intermittent blurring of vision with halos seen around lights
(Due to corneal edema) - Photophobia, and visual loss
- IOP >21 mmHg (often 40‐80 mmHg)
- Conjunctival injection
- Corneal epithelial edema causing haziness,
Fixed and mid‐dilated pupil, and shallow anterior chamber - Easily missed :
Pts who present primarily with headache or abdo pain and vomiting
隅角閉鎖型青光眼
- 單側眼痛
- 頭痛
- 視力模糊
- 紅眼 (結膜充血)
- 虹視
- 噁心嘔吐
- Pupil dilated, no Light reflex
* Signs that suggest a rapid rise in intraocular pressure ( IOP ) :
- Conjunctival redness
- Corneal edema or cloudiness
- Shallow anterior chamber
- A mid-dilated pupil (4 - 6 mm) that reacts poorly to light
Initial management of acute angle closure glaucoma :
1. Supine position - Lay patient flat
2. Timolol 0.5% gtt q30min
3. Acetazolamide 500mg PO or IV
4. Mannitol 1-2g/kg IV
5. Pilocarpine 2% gtt q15min
WFH :
1. Acetazolamide 2 tab stat +1 tab BID for 3 days (CA inhibitor)
2. Azopt eye drop 1% 5mL/bot, 1 Drop TID, OU (Brinzolamide)
3. Alphagan P 0.15% 5mL/bot, 1 Drop TID, OU (alpha 2 agonist)
4. Taflotan 2.5mL/bot, 1 Drop HS, OU (Prostaglandin)
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