Mydriatic angle-closure glaucoma--mechanism, evaluation and reversal

Area of Science:

• Ophthalmology
• Optometry
• Ocular Pharmacology

Background:

• Ocular mydriatics are essential for ophthalmoscopic examinations.
• A potential iatrogenic side effect of mydriatics is acute angle-closure glaucoma.
• Optometrists must be aware of this risk.

Purpose of the Study:

• To summarize the mechanism of mydriatic-induced angle-closure glaucoma.
• To highlight the importance of evaluating anterior chamber depth before mydriasis.
• To present methods for assessing anterior chamber angles.

Main Methods:

• Review of the mechanism of mydriatic angle-closure glaucoma.
• Description of oblique illumination shadow test for angle estimation.
• Description of van Herick slit lamp test for angle estimation.

Main Results:

• Shallow anterior chamber is a key risk factor for angle-closure.
• Oblique illumination and van Herick tests accurately estimate anterior chamber angles.
• Risk of angle-closure approaches zero with proper pre-evaluation.

Conclusions:

• Pre-mydriasis evaluation of anterior chamber angle is critical.
• Specific tests can accurately assess angle depth.
• Management strategies for acute angle-closure attacks are discussed.