**Question:** The treatment of choice of fellow eye of acute angle closure glaucoma is –

A. Laser peripheral iridotomy
B. Medical management
C. Medical management and observation
D. Medical management and surgical management

**Correct Answer:** A. Laser peripheral iridotomy

**Core Concept:**
Acute angle closure glaucoma is a life-threatening emergency that requires prompt treatment to prevent severe vision loss and blindness. In the fellow eye of a patient with acute angle closure glaucoma, the primary goal is to prevent the development of the condition and to maintain the eye's health.

**Why the Correct Answer is Right:**
The correct answer, Laser peripheral iridotomy (LPI), is a non-surgical procedure used to alleviate the risk of acute angle closure glaucoma in the fellow eye. In acute angle closure glaucoma, the iris tissue constricts the angle, causing increased intraocular pressure (IOP) and potentially leading to vision loss. A laser is used to create an opening (called an iridotomy) in the peripheral iris, allowing the aqueous humor to flow more freely and reducing IOP.

**Why Each Wrong Option is Incorrect:**

B. Medical management: While medical management is essential in treating acute angle closure glaucoma, it is not the primary intervention for preventing the development of the condition in the fellow eye. Medical management focuses on reducing IOP and managing symptoms, but does not address the underlying issue of iris constriction.

C. Medical management and observation: Observation alone is insufficient to prevent acute angle closure glaucoma in the fellow eye. Medical management is essential, but observation alone does not address the primary cause of the condition.

D. Medical management and surgical management: Surgical management, such as LPI, is the primary intervention for preventing acute angle closure glaucoma in the fellow eye. While medical management is essential in treating the condition, surgical management addresses the primary cause by improving aqueous humor drainage and preventing further attacks.

**Clinical Pearl:**
In cases of acute angle closure glaucoma, it is crucial to perform Laser Peripheral Iridotomy (LPI) in the fellow eye to prevent the development of the condition and ensure long-term eye health. Medical management and surgical management should be used in combination to address the increased intraocular pressure, manage symptoms, and prevent the constriction of the iris and subsequent angle closure.