An acute angle closure crisis can respond to drugs, but ophthalmologists may advise a laser iridotomy using a YAG (yttrium aluminium garnet) laser to create a small hole in the iris to improve drainage.^18,26

Immediate treatment will include analgesia and use of antiemetics for the somatic effects while the cause of the acute angle closure crisis is being assessed, so a secondary glaucoma can be ruled out. Topical pilocarpine could aggravate and prolong the pain in acute angle closure if the problem is due to the lens or something behind the lens, when atropine or cyclopentolate should be considered.²⁷

If acute angle closure is diagnosed, initial treatment is with dorzolamide 2% and timolol 0.5% eye drops in combination, apraclonidine 0.5% eye drops, and pilocarpine 2% eye drops, but defer this if the IOP is 40 mmHg or higher, in which case intravenous acetazolamide 250mg may be appropriate.²⁷

If possible, a laser peripheral iridotomy should be done once the patient is stable, followed by dexamethasone 0.1% or prednisolone 1% eye drops for a week.²⁷