Acute angle-closure glaucomaRefer

• Acetazolamide (not in sulfa allergy or sickle cell), Timolol 0.5% eye drops, Brimonidine 0.2% eye drops, Pilocarpine 2% eye drops, Mannitol 20% (pressure still high; not in heart or kidney failure), Prednisolone acetate 1% eye drops

• Definitive: Laser peripheral iridotomy to both eyes once the cornea clears — ophthalmology the same day (AAO PPP 2026)

Start pressure-lowering treatment at once and refer to an ophthalmologist the same day.

First visit

• Eye pressure (IOP) — Tonometry; often over 40 mmHg.
• Visual acuity — Both eyes.
• Creatinine and potassium — Before or soon after acetazolamide and mannitol.

Only if indicated

• Gonioscopy — After the attack, both eyes.
• Blood glucose — Before mannitol in a diabetic.