Glaucoma · NEET PG Preparation Ophthalmology
A 65-year-old man presents with sudden onset severe eye pain, headache, nausea, and vomiting in his right eye. On examination, the visual acuity is c…
Practice question from Glaucoma (NEET PG Preparation Ophthalmology), with the correct answer and a step-by-step solution.
medium · MCQ · Q-5C740F
A 65-year-old man presents with sudden onset severe eye pain, headache, nausea, and vomiting in his right eye. On examination, the visual acuity is counting fingers, the right pupil is mid-dilated and non-reactive, and the cornea is hazy with epithelial edema. Intraocular pressure (IOP) is 58 mmHg. Gonioscopy of the left eye reveals a narrow angle with a convex iris plane. What is the most appropriate immediate medical therapy to lower the intraocular pressure before definitive surgical intervention?
- A.Intravenous Mannitol and topical PilocarpineCorrect answer
- B.Topical Atropine and intravenous Acetazolamide
- C.Topical Timolol and latanoprost
- D.Intravenous steroids and topical Phenylephrine
Solution
The patient has an acute angle-closure glaucoma attack. Immediate treatment aims to reduce IOP rapidly and break the pupillary block. Intravenous mannitol (osmotic agent) rapidly dehydrates the vitreous. Topical pilocarpine (miotic) pulls the iris away from the trabecular meshwork once ischemia of the iris sphincter is reversed (usually after IOP is partially lowered). Atropine, phenylephrine, and latanoprost are contraindicated or ineffective in acute angle closure.
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