Question

A 34-year-old woman presents to the ED with severe right eye pain. The pain began after she entered a dark movie theatre. On physical exam, you note a mid-dilated pupil (4 mm) and corneal edema. Which of the following is the correct series of treatment for this process?

a) Acetazolamide IV, topical timolol, topical prednisolone, topical pilocarpine
b) Mannitol IV, topical pilocarpine, topical timolol, topical prednisolone
c) Topical prednisolone, mannitol IV, topical timolol, topical pilocarpine
d) Topical timolol, topical pilocarpine, acetazolamide IV, topical prednisolone

Answer 1

The treatment for the symptoms suggestive of acute angle-closure glaucoma includes Mannitol IV, topical pilocarpine, topical timolol, and topical prednisolone.

Step-by-step explanation:

The correct series of treatment for a patient presenting with symptoms suggestive of acute angle-closure glaucoma, shown by severe eye pain after entering a dark place, mid-dilated pupil, and corneal edema, would be:

1. Mannitol IV to rapidly reduce intraocular pressure.
2. Topical pilocarpine to constrict the pupil and open the trabecular meshwork for aqueous humor drainage.
3. Topical timolol to decrease aqueous humor production.
4. Topical prednisolone to reduce inflammation.

These medications work synergistically to lower intraocular pressure and reduce the risk of optic nerve damage. Pilocarpine and timolol are particularly crucial in managing glaucoma. Prednisolone is used with caution, as it may increase the pressure but is helpful for inflammatory relief.