Typical management for acute angle-closure glaucoma?

• A. Emergency ophthalmology referral
• B. Oral acetazolamide and topical agents
• C. Topical antihistamines or decongestants
• D. Oral analgesics and observation

Answer: (C)

Acute angle-closure glaucoma is an ophthalmic emergency and requires rapid reduction of intraocular pressure to prevent vision loss. The typical approach combines systemic and topical medications to quickly decrease aqueous humor production and enhance outflow. Giving an oral acetazolamide helps block carbonic anhydrase, markedly reducing aqueous humor formation and lowering IOP fast. At the same time, topical agents such as a beta-blocker (to further reduce production) and an alpha-2 agonist (to cut production further) are used. Once the pressure begins to fall, pilocarpine may be added to induce miosis and pull the iris away from the trabecular meshwork, helping reopen the angle. Definitive management with laser peripheral iridotomy is arranged promptly by ophthalmology.

Meds that dilate the pupil, like many antihistamines or decongestants, can worsen angle closure and are not appropriate in this setting. Supportive care, including analgesia and antiemetics, may help comfort, but they do not address the underlying mechanism. Urgent ophthalmology referral is essential for definitive treatment.