What is the treatment for primary angle closure glaucoma?

Primary angle closure glaucoma = iris acutely bulges forward obliterating angle between cornea and iris, closing off outflow of aqueous humor through canal of Schlemm

Treatment:

• topical timolol 0.5% - non-selective beta-blocker that reduces aqueous humor production. Systemic absorption and adverse effects may occur.


• topical pilocarpine 1% - 2% - stimulates cholinergic receptors in eye causing miosis which decreases resistance to aqueous humor outflow


• topical alpha-2 agonist (apraclonidine 1.0%) - reduces aqueous humor formation


• IV acetazolamide - carbonic anhydrase inhibitor that decreases aqueous humor production. Don't use in patients with sulfa allergy.


• ophthalmologic consultation for definitive treatment

Note: these treatments do not necessarily apply to primary open angle glaucoma, secondary open angle glaucoma or secondary angle closure glaucoma.

Source

Marx: Rosen's Emergency Medicine: Concepts and Clinical Practice, 6th ed.