Opthal: Acute Angle-Closure Glaucoma: Free MSRA Podcast

👁️Deep Dive: AcuteAngle Closure Glaucoma (AACG)In this episode, weexplore acute angle closure glaucoma (AACG)— a true ophthalmic emergency that everyMSRA candidate should be ready to spot. Think suddenpainful red eye, vision loss, and urgent action. We break downeverything you need to know — no fluff, just high-yield content. 🧠What is AACG?AACG is a rapid rise in intraocular pressure (IOP) due toclosure of the drainage angle in theanterior chamber. This compresses the optic nerve — sight-threatening if not treated fast.📌 Glaucoma = Optic nerve damage ± raised IOP📌 AACG = IOP spike due to blocked drainage📌 Emergency = Permanent vision loss risk withinhours 🔍Causes & Triggers🎯Primary = Pupillary block → Iris bows forward → Angleshuts🎯Secondary = Tumour, inflammation, trauma, meds (e.g.anticholinergics)🕶️Triggers:• Dim light (e.g.cinema)• Pupil dilation(mydriasis)• Certainmedications (antidepressants, antihistamines, tropicamide) ⚠️Risk Factors –Mnemonic: "Old Asian Farsighted Female in Dim Light"🔹 Older age🔹 Asian ethnicity🔹 Female sex🔹 Hyperopia (farsightedness)🔹 Family history🔹 Dim environments 🩻Pathophysiology Recap• Aqueous humourcan’t drain → IOP spikes• Optic nervecompressed• Corneal oedemafrom pressure• Vision damage canbe permanent if untreated 👀Clinical Features –Classic Triad🔴 Painful red eye🌈 Halos around lights👁️ Mid-dilated, fixed pupilPlus:🤕 Severe headache🤮 Nausea & vomiting🌫️ Blurred or sudden loss of vision💥 Steamy cornea, shallow anterior chamber 🩺DifferentialDiagnosis – Mnemonics for MSRAFor Raised IOP: "Trauma PigmentPoses" =• Traumatic glaucoma• Pigment dispersion• Posner-SchlossmansyndromeFor Painful Vision Loss: "CUSNSEO" =• Corneal abrasion• Uveitis• Scleritis• Neuritis (optic)• Scleritis• EndophthalmitisFor Red Eye Causes: "Concord" =• Conjunctivitis• Corneal pathology• Trauma 🔬Investigations• Clinical diagnosis= key• Tonometry =confirms high IOP• Gonioscopy =visualises closed angle• Slit-lamp =corneal haze, shallow chamber• OCT = ifgonioscopy unclear• Fundoscopy = opticdisc cupping🧪 Diagnostic Criteria (simplified):✔️ ≥2 symptoms (e.g. pain, nausea, halos)✔️ ≥3 signs (e.g. IOP >21, redness, cornealoedema, fixed pupil) 🚨Emergency ManagementGOAL: Lower IOP rapidly and prevent optic nervedamage1️⃣Medical Management• Acetazolamide(IV/oral) – ↓ aqueous production• Pilocarpine –constricts pupil• Timolol,Apraclonidine – topical drops• Mannitol IV –osmotic agent (if needed)• Analgesia +antiemetics2️⃣Definitive Treatment🔸Laser PeripheralIridotomy (LPI)— Tiny hole in iris= bypass block— Often done in both eyes to prevent fellow eye attack3️⃣Secondary AACG— Treat underlyingcause (e.g. tumour, uveitis) 🔁Prognosis &Complications✔️ Good if treated early✖️ Poor if delayed – permanent vision loss likely⚠️ Risk of:• Optic nerve damage• Recurrent attacks• Chronic angleclosure glaucoma• Fellow eye attack• Rare: Retinalvein/artery occlusion 🎓Key Takeaways• AACG = trueemergency• Act FAST: triad ofpain, vision loss, mid-dilated pupil• Risk factors: Old Asian female with hyperopia in dim light• Management: Medical rescue → LPI• Always assess the fellow eye• Early detection =sight-saving 📚Useful MSRAResources:• RevisionNotes• Flashcards• AccordionQ&A• RapidQuiz• QuizPage 🌐 For more revision tools and ophthalmology content:🔗PassTheMSRA.com🔗FreeMSRA.com#MSRA#AcuteAngleClosureGlaucoma #Ophthalmology #MSRAQuiz #MSRAFlashcards#MSRATextbook #MSRARevisionNotes #OphthalmologyEmergency #IOPEmergency#LaserIridotomy #MSRAOphthalmology