Treatment of choice of prophylaxis of Left eye in a case of Acute Angle Closure glaucoma of right eye
**Core Concept**
In the context of acute angle closure glaucoma, prophylactic treatment is aimed at preventing the attack in the fellow eye, typically the left eye. This is achieved by reducing intraocular pressure (IOP) and preventing the iris from coming into contact with the trabecular meshwork.
**Why the Correct Answer is Right**
The treatment of choice for prophylactic treatment of the left eye is **pilocarpine**, a miotic agent that causes the iris to constrict and move away from the angle, thereby preventing angle closure. Pilocarpine acts by stimulating muscarinic receptors in the iris sphincter muscle, leading to its contraction. This reduces the risk of angle closure and subsequent increase in IOP.
**Why Each Wrong Option is Incorrect**
**Option A:** Atropine is a mydriatic agent that would actually increase the risk of angle closure by dilating the pupil and allowing the iris to come into contact with the trabecular meshwork.
**Option B:** Timolol is a beta-blocker that reduces IOP by decreasing aqueous humor production, but it does not specifically prevent angle closure and is not the treatment of choice for prophylaxis.
**Option C:** Acetazolamide is a carbonic anhydrase inhibitor that reduces IOP by decreasing aqueous humor production, but it is not a miotic agent and does not prevent angle closure.
**Clinical Pearl / High-Yield Fact**
In patients with a history of acute angle closure glaucoma, prophylactic treatment of the fellow eye with a miotic agent like pilocarpine is essential to prevent future attacks and preserve vision.
**Correct Answer:** B. Pilocarpine.