0071643192.pdf

HEAD, EYE, EAR, NOSE, AND THROAT

EMERGENCIES

■ Facilitate outflow of the aqueous humor:

■ Miotics/cholinergics (pilocarpine) = constricts the pupil thus decreas-

ing the obstruction and allowing outflow

■ Prostaglandin agonists (latanoprost) = increases uveoscleral outflow of

aqueous humor

■ Emergent ophthalmology consult: The definitive treatment is laser peri-

pheral iridotomy. This is usually performed at 24–48 hours, but may be

necessary emergently if medical treatment fails to sufficiently lower IOP or

break the attack.

FIGURE 14.38. Acute angle closure glaucoma. Note the hazy or “steamy” cornea and

mid-dilation of the pupil.

(Courtesy of Gary Tanner, MD as reproduced, with permission, from Knoop KJ, Stack LB,

Storrow AB. Atlas of Emergency Medicine, 2nd ed. New York: McGraw-Hill, 2002:49.)

FIGURE 14.39. (A) Normal flow of aqueous from ciliary body, through the pupil and out

through the trabecular meshwork and Schlemm canal, located in the anterior chamber angle.

(B) Angle-closure glaucoma with pupillary block. Iris leaflet bows forward, blocking the chamber

angle and prohibiting aqueous outflow. Meanwhile, aqueous production continues and IOP rises.

(Reproduced, with permission, from Tintinalli JE, Kelen GD, Stapczynski SJ. Emergency

Medicine: A Comprehensive Study Guide, 6th ed.New York: McGraw-Hill, 2004:1459.)

Conjunctiva

Episcleral

vein

Trabecular

meshwork

Zonules

Ciliary body

Schlemm’s

canal

Aqueous vein

Iris

Aqueous

flow

Lens

A

B