This handout is for acute angle-closure glaucoma (aacg). Your care team identified this based on: severe acute unilateral eye/brow pain with blurred vision and coloured halos around lights (classic aacg triad — aao ppp gedde ophthalmology 2021 pmid 34933744).
Other reasons your team may use this plan: acute red painful eye with frontal headache and nausea/vomiting — the systemic-mimic presentation that masquerades as acute abdomen / migraine / gastroenteritis (weinreb jama 2014 pmid 24825645); exam finding: red eye + mid-dilated fixed/oval poorly-reactive pupil + steamy/hazy cornea + shallow anterior chamber (cardinal aacg sign cluster — aao ppp gedde ophthalmology 2021); new topiramate / sulfonamide / sympathomimetic / anticholinergic / daratumumab with acute bilateral visual blurring + eye pain — secondary angle-closure entry (agarwal indian j ophthalmol 2019 pmid 31436195; edwards j glaucoma 2020 pmid 32487951).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| supine_positioning | — | — | — | AAO PPP Gedde Ophthalmology 2021 — supine posture lets the lens-iris diaphragm fall back, deepening the angle while the bundle takes effect |
| corneal_indentation_central_pressure | — | — | — | AAO PPP Gedde Ophthalmology 2021 — corneal indentation can mechanically force aqueous into the periphery and transiently break appositional closure |
| stat_ophthalmology_activation | — | — | — | Weinreb JAMA 2014 (PMID 24825645) — IOP reduction is the only proven means of preventing irreversible optic-nerve damage; definitive laser is ophthalmology-delivered and time-critical |
| STOP_precipitant_drug_if_secondary_closure | — | — | — | Agarwal Indian J Ophthalmol 2019 (PMID 31436195); Edwards J Glaucoma 2020 (PMID 32487951) — drug-induced ciliochoroidal-effusion secondary closure responds to drug cessation + cycloplegia + steroid, NOT to pilocarpine or iridotomy |
Plan: Acute angle-closure crisis — stepwise IOP-lowering bundle (bridge) → definitive laser PI
Call 911 or go to the nearest emergency room right away if you have:
Definitive LPI of the affected eye and PROPHYLACTIC LPI of the anatomically-narrow fellow eye (untreated fellow-eye attack risk is substantial in symptomatic angle closure — distinct from screen-detected ZAP suspects where prophylaxis benefit is modest, He Lancet 2019 PMID 30878226); EAGLE early-lens-extraction discussion in lens-driven disease (Azuara-Blanco Lancet 2016 PMID 27707497); lifelong glaucoma surveillance for residual optic-nerve damage / chronic angle closure; permanent documentation + deprescribing of the precipitant drug and patient warning card; route chronic IOP care and precipitant medication review out by engine_id
Guideline: AAO Primary Angle-Closure Disease Preferred Practice Pattern (Gedde et al, Ophthalmology 2021;128:P30-P70) + EAGLE clear-lens-extraction RCT (Azuara-Blanco et al, Lancet 2016) + ZAP prophylactic-LPI RCT (He et al, Lancet 2019) + Weinreb/Aung/Medeiros JAMA 2014 glaucoma pathophysiology & treatment review + Emanuel/Parrish/Gedde Curr Opin Ophthalmol 2014 evidence-based PAC management