The Wills Eye Manual Office and Emergency Room Diagnosis and Treatment of Eye Disease 7th Edition by Nika Bagheri

Author:Nika Bagheri [Nika Bagheri]
Language: eng
Format: epub
Publisher: LWW; Seventh edition (June 11, 2016)
Published: 2020-03-14T00:00:00+00:00

inflammatory drugs (NSAIDs) (e.g., ketorolac q.i.d.) may also be effective.3. Consider a systemic CAI (e.g., acetazolamide 500 mg sequel p.o. b.i.d.) if IOP issignificantly increased and unresponsive to topical therapy (rare).4. Hyperosmotic agents (e.g., mannitol 20% 1 to 2 g/kg i.v. over 45 minutes) oranterior chamber paracentesis can be considered when the IOP is determined tobe dangerously high for the involved optic nerve ( SEE A PPENDIX 13, A NTERIOR C HAMBER P ARACENTESIS ).

5. Consider a cycloplegic agent (e.g., cyclopentolate 1% t.i.d.) if the patient issymptomatic.

Follow-Up

1. Patients are seen every few days at first and then weekly until the episoderesolves. Attacks usually subside within a few hours to a few weeks.2. Medical or surgical therapy may be required, depending on the baseline IOPbetween attacks.3. If the IOP decreases to levels not associated with disc damage, no treatment isnecessary.4. Steroids are tapered rapidly if they are used for 1 week or less and slowly ifthey are used for longer.5. Both eyes are at risk for the development of chronic open angle glaucoma.Patients should be followed as if the diagnosis is POAG. S EE 9.1, P RIMARY O PEN A NGLE G LAUCOMA .

9.9 Steroid-Response Glaucoma

Signs

Critical. Increased IOP with the use of corticosteroids. Usually takes 2 to 4 weeksafter starting ocular (e.g., topical, intravitreal) steroids, though rarely there canbe an acute rise of IOP within hours in association with systemic use of steroid oradrenocorticotropic hormone (ACTH).

Other. Signs of POAG may develop. S EE 9.1, P RIMARY O PEN A NGLE G LAUCOMA .

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