(A) Medical therapy

1. Systemic hyperosmotic agent intravenous

mannitol (1 gm/kg body weight) should be given

initially to lower IOP.

2. Acetazolamide (a carbonic anhydrase inhibitor)

500 mg intravenous injection followed by 250 mg

tablet should be given 3 times a day.

3. Analgesics and anti-emetics as required.

4. Pilocarpine eyedrops should be started after the

IOP is bit lowered by hyperosomtic agents. At

higher pressureiris sphincter is ischaemic and

unresponsive to pilocarpine. Initially 2 percent

pilocarpine should be administered every 30

minutes for 1-2 hours and then 6 hourly.

5. Beta blocker eyedrops like 0.5 percent timolol

maleate or 0.5 percent betaxolol should also be

administered twice a day to reduce the IOP.

6. Corticosteroid eyedrops like dexamethasone or

betamethasone should be administered 3-4 times

a day to reduce the inflammation.

(B) Surgical treatment

1. Peripheral iridotomy. It is indicated when

peripheral anterior synechiae are formed in less

than 50 percent of the angle of anterior chamber

and as prophylaxis in the other eye. Peripheral

iridotomy re-establishes communication between

posterior and anterior chamber, so it bypasses

the pupillary block and thus helps in control of

PACG. Its surgical technique is described on

page 237.

Laser iridotomy, a non-invasive procedure, is a

good alternative to surgical iridectomy.

2. Filtration surgery. It should be performed in

cases where IOP is not controlled with the best

medical therapy following an attack of acute

congestive glaucoma and also when peripheral

anterior synechiae are formed in more than 50

percent of the angle of the anterior chamber.

Mechanism: Filtration surgery provides an

alternative to the angle for drainage of aqueous

from anterior chamber into subconjunctival

space.For surgical technique, see page 238.

3. Clear lens extraction by phacoemulsification with

intraocular lens implantation by has recent been

recommended by some workers