Review Question - QID 217794

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Glaucoma Angle-Closure Glaucoma Etiology QID: 217794 (M1.OMB.1)

QID 217794 (Type "217794" in App Search)

A 46-year-old woman presents to the emergency department with a 1-hour history of right eye pain. She says that she underwent a number of routine check-ups today and felt fine for those visits; however, when she returned home she started noticing right eye pain that quickly became excruciating. This was associated with a headache primarily in the front of the head as well as blurry vision and halos around lights. Her temperature is 98.6°F (37°C), blood pressure is 125/82 mmHg, pulse is 110/min, and respirations are 15/min. On physical exam, she is found to have dilation of her right pupil that is minimally reactive. Which of the following medications is most likely to cause this patient's condition?

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Acetazolamide

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Atropine

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Brimonidine

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Pilocarpine

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Timolol

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This patient who presents with severe eye pain, frontal headache, visual defects, fixed pupillary dilation, most likely has acute angle-closure glaucoma. This disease can be caused by the anticholinergic medication atropine because this medication reduces the outflow of aqueous humor.

Glaucoma refers to a state of elevated intraocular pressure that can result in long-term visual damage. Angle-closure glaucoma is a form of glaucoma that is more common in people of Asian descent and presents with an extremely painful eye associated with frontal headache, photophobia, blurry vision, halos around lights, a "rock-hard" eye, fixed-dilated pupil, corneal clouding, and conjunctival injection. The etiology of angle-closure glaucoma is the obstruction of aqueous humor flow between the iris and the cornea. This disease can be caused by infection, lens dislocation, or mydriatic agents such as atropine because pupil dilation reduces aqueous humor outflow. Atropine is used to dilate the pupils during eye exams.

Lachkar et la. studied drug-induced angle-closure glaucoma and found that this can be caused by a wide variety of drugs including anticholinergic agents.

Incorrect Answers:
Answer 1: Acetazolamide is a carbonic anhydrase inhibitor that can be used in the treatment of glaucoma. This drug functions in the eye by decreasing the production of aqueous humor.

Answer 3: Brimonidine is an alpha-2-adrenergic agonist that can be used in the treatment of glaucoma. This drug functions in the eye by decreasing sympathetic outflow to the pupillary dilators and allows for increased drainage of the eye.

Answer 4: Pilocarpine is a cholinergic agonist that can be used in the treatment of glaucoma. This drug functions in the eye by inhibiting mydriasis and allowing for increased drainage of the eye.

Answer 5: Timolol is a beta-adrenergic blocker that can be used in the treatment of glaucoma. This drug functions in the eye by reducing the production of aqueous humor.

Bullet Summary:
Anticholinergic medications such as atropine can cause acute angle closure glaucoma.

Drug-induced acute angle closure glaucoma.

Yves Lachkar,

Walid Bouassida

General

Yves Lachkar, 2007

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