Manual

Acute angle-closure crisis

Emergencies

Acute angle-closure crisis

Painful red eye, halos, nausea, mid-dilated pupil.

  • Symptoms: ocular pain, headache, blurred vision, halos, nausea/vomiting.
  • Signs: IOP often 40–80 mmHg, corneal edema, shallow AC, fixed mid-dilated pupil, ciliary flush.
  1. 1Timolol 0.5%, brimonidine 0.1–0.2%, dorzolamide 2% — one drop each, 1 min apart.
  2. 2Acetazolamide 500 mg IV/PO (if no sulfa allergy / renal contraindication).
  3. 3Topical prednisolone acetate 1%.
  4. 4Pilocarpine 1–2% once IOP < 40 mmHg (iris ischemia makes it ineffective above that).
  5. 5Hyperosmotics (mannitol IV) if refractory; recheck IOP hourly.
  6. 6Definitive: laser peripheral iridotomy to both eyes (fellow eye is at high risk).
Avoid pilocarpine in lens-induced or aqueous misdirection mechanisms. Topiramate-induced closure is from ciliochoroidal effusion — stop drug, use cycloplegia; iridotomy does not help.
NextOpen globe injury

Educational summary — follow local protocols and current guidelines.