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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