What is the role of the ophthalmologist in the treatment of acute angle-closure glaucoma (AACG)?

Updated: Nov 19, 2018
  • Author: Joseph Freedman, MD; Chief Editor: Steven C Dronen, MD, FAAEM  more...
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Answer

The choice of which therapy to use will be made by an ophthalmologist who will evaluate all patients via gonioscopy with complete inspection of the angle. At institutions where ophthalmologic consultation is immediately available, initial treatment should be performed in conjunction with the specialist.

If ophthalmologic consultation is not immediately available, the emergency department physician must begin pharmacologic therapy as described above. After appropriate therapy aimed at IOP reduction, ophthalmologic evaluation must be ensured by transferring the patient, if necessary. If the IOP is unchanged or increased, with appropriate pharmacologic therapy, the attack most likely will terminate only with LPI. Because outcome is adversely affected by the duration of symptoms, expeditious evaluation by a specialist is required. Ocular massage through a closed eyelid may be performed while waiting for ophthalmology if no other treatment reduces IOP.


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