A 55 years lady presented with sudden onset of severe pain in the eye with, Shallow anterior chamber. Treatment of choice is
**Core Concept**
A shallow anterior chamber in the eye, often accompanied by severe pain, is a hallmark of acute angle-closure glaucoma. This condition occurs when the iris suddenly blocks the drainage angle of the eye, leading to a rapid increase in intraocular pressure (IOP). Prompt treatment is essential to prevent permanent vision loss.
**Why the Correct Answer is Right**
The treatment of choice for acute angle-closure glaucoma is the administration of intravenous mannitol and acetazolamide. Mannitol is an osmotic diuretic that helps reduce IOP by increasing the osmotic pressure in the vitreous humor, allowing fluid to leave the eye. Acetazolamide, a carbonic anhydrase inhibitor, also reduces IOP by decreasing the production of aqueous humor. This combination of medications is used to rapidly lower IOP and alleviate symptoms.
**Why Each Wrong Option is Incorrect**
**Option A:** Atropine is an anticholinergic medication that can be used to dilate the pupils, but it does not address the underlying cause of acute angle-closure glaucoma. In fact, using atropine in this scenario can worsen the condition by allowing the iris to block the drainage angle further.
**Option C:** Atenolol is a beta-blocker that can be used to treat glaucoma by reducing the production of aqueous humor, but it is not the treatment of choice for acute angle-closure glaucoma. Beta-blockers are typically used in the long-term management of open-angle glaucoma.
**Option D:** Steroids, such as IV hydrocortisone, are not used to treat acute angle-closure glaucoma. While steroids may be used in other ocular conditions, such as uveitis, they do not have a role in the management of acute angle-closure glaucoma.
**Clinical Pearl / High-Yield Fact**
In cases of suspected acute angle-closure glaucoma, it is essential to perform a thorough eye examination, including measurement of IOP, and to initiate treatment promptly. The "Cogan-Reese" reflex, characterized by a mid-dilated pupil that reacts poorly to light, is a classic sign of acute angle-closure glaucoma.
**✓ Correct Answer: B. I/V mannitol & Acetazolamide**