A 60-year-old woman presents to the emergency department with sudden onset of severe right-sided headache, nausea, vomiting, and blurred vision with halos around lights. Examination reveals a mid-dilated, fixed pupil, corneal oedema, and an IOP of 52 mmHg. The most important immediate step is:

• A Emergency trabeculectomy
• B Pupil dilation with atropine
• C Referral to neurologist for migraine workup
• D Topical timolol, systemic acetazolamide, and IV mannitol to lower IOP ✓

Explanation

This is a classic presentation of acute angle-closure glaucoma (AACG), an ophthalmic emergency. The immediate goal is to lower IOP rapidly using a combination of topical beta-blocker (timolol), systemic carbonic anhydrase inhibitor (acetazolamide), and intravenous hyperosmotic agent (mannitol) to break the attack before performing definitive laser peripheral iridotomy (LPI). Atropine would worsen the attack by dilating the pupil further.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.