Emergencies in glaucoma: a review

Most severe eye diseases and injuries ultimately require intervention by an ophthalmologist. The urgency of referral depends on various factors, including level of vision loss, duration of symptoms, and presence of comorbid diseases. Of special importance are five acute eye problems in which emergency management by primary care physicians can be critical to visual outcome: high-velocity injuries, chemical injuries, acute angle-closure glaucoma, arteritic ischemic optic neuropathy, and central retinal artery occlusion. This paper will focus on emergencies in glaucoma, especially primary and secondary closed-angle glaucoma and secondary open-angle glaucoma. Delay in presentation, and unresponsiveness to medical treatment of the acute ocular hypertension attack carry a significant risk of chronic glaucoma, whatever the mechanism of disease is. Whenever the acute glaucoma crisis does not cease with an appropriate medical treatment, a laser and/or surgical intervention needs to be urged.