Acute Glaucoma

Acute glaucoma must be differentiated from chronic glaucoma, which is not an ophthalmic emergency. An eye with acute glaucoma will typically appear cloudy from corneal edema, and/or uveitis. Moderate to severe conjunctival hyperemia and scleral vascular congestion are also common. The pupil of the eye may be mid-range to mydriatic and vision is variable, although usually absent. An eye with chronic glaucoma is typically blind, mydriatic, and buphthalmic, in addition to appearing cloudy and red. A brief physical examination with basic labwork and evaluation of intraocular pressures by rebound/applanation tonometry should be performed. Intravenous mannitol can be used to decrease intraocular pressures if appropriate. Topical carbonic anhydrase inhibitors and prostaglandin analogues can be prescribed. Topical and systemic steroidal or non-steroidal anti-inflammatories (depending on the patient’s health and physician preference) and systemic analgesia are recommended. Referral for specialist evaluation and treatment should be strongly considered.