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| ==Background==
| | #REDIRECT [[Acute angle-closure glaucoma]] |
| *An optic neuropathy characterized by an increase in intraocular pressure leading to damage to the optic nerve and irreversible vision loss.
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| *Second leading cause of irreversible blindness worldwide
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| ===Risk Factors===
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| *Age (4% prevalence in age >80)
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| *Race (3 times higher in Black patients)
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| *Family History (2-3 fold increase for individuals with affected sibling or parent)
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| *[[Hypertension]]
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| *[[Diabetes]]
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| *Other: Myopia, pseudoexfoliation, low diastolic perfusion pressure, cardiovascular disease, [[hypothyroidism]]
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| ===Pathophysiology===
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| Not entirely clear, but may be related to an increased intraocular pressure that leads to compression of the optic nerve at the site where it exits the eye. This causes a progressive decrease in the number of retinal ganglion cells.
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| ==Clinical Features==
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| ''Most commonly presents with progressive peripheral vision loss, followed by central vision loss''
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| *Painless
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| *Cupping of the optic disc
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| *Loss of peripheral visual field
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| *Preservation of central vision
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| ==Differential Diagnosis==
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| {{Acute vision loss noninflamed DDX}}
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| ==Evaluation==
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| ===Testing===
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| ====[[Fundus examination]]====
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| *Cupping >50% of the vertical disc diameter
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| *Thinning or notching of disc rim
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| *Progressive change of size/shape of cup
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| [[File:glaucoma-cupping-1024x414.jpg|thumb|Glaucoma cupping]]
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| ====[[Visual field testing]]====
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| ====[[Intraocular pressure]]====
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| *Does not establish diagnosis of Open angle glaucoma. 1/2 of patients with OAG have normal intraocular pressure
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| *Normal Intraocular pressure ranges from 10 to 20 mmHg
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| *Pressure >21 mmhg considered ocular hypertension
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| ===Diagnosis===
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| At least one of the following:
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| *Evidence of optic nerve damage from structural abnormalities (thinning, cupping, notching of disc rim)
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| *Adult Onset
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| *Open, normal appearing anterior chamber angles
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| *Absence of known secondary causes of open-angle glaucoma
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| ==Management==
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| *β-blockers: [[Timolol]] maleate 0.25%-0.5%, one drop BID
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| *α-adrenergic agonist: Brimonidine 0.2% one drop BID
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| *Carbonic Anhydrase inhibitors: Dorzolamide 2% one drop BID
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| *Prostaglandins: Latanoprost 0.005% one drop qD
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| *Persistent elevated intraocular pressures: [[Acetazolamide]] 125-250mg PO bid-QID
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| ==Disposition==
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| Indications for ophthalmologic referral:
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| *IOP>40mmHg: emergency referral
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| *IOP 30-40 mmHg: referral within 24hr if no symptoms suggesting acute glaucoma
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| *IOP 25-29 mmHg: Evaluation within 1 week
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| *IOP 23-24 mmHg: repeat measurement and referral for comprehensive eye examination
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| ==See Also==
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| *[[Acute vision loss (noninflamed)]]
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| *[[Acute angle-closure glaucoma]]
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| ==External Links==
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| ==References==
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| <references/>
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| [[Category:Ophthalmology]]
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