In a case of acute angle closure crisis with IOP of 60 mmHg unresponsive to topical therapy alone, intravenous mannitol is considered. In which comorbidity would intravenous mannitol be CONTRAINDICATED?

• A Congestive cardiac failure ✓
• B Controlled type 2 diabetes mellitus
• C Mild chronic stable angina
• D Previous uncomplicated cataract surgery in the fellow eye

Explanation

Mannitol acts as an osmotic agent that draws water from the vitreous into the extracellular compartment and produces a brisk intravascular volume expansion before diuresis begins. This sudden load can precipitate pulmonary oedema and decompensate congestive cardiac failure, so it is contraindicated. Diabetes is only a relative concern, and angina or prior surgery in the other eye does not preclude its short-term use in an acute sight-threatening crisis.

Reference: Parsons' Diseases of the Eye, 22nd ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.