The treatment of choice of angle closure glaucoma is –
The correct answer is probably a laser procedure. I remember that laser peripheral iridotomy (LPI) is the main treatment. It creates a small hole in the iris to equalize pressure between the anterior and posterior chambers, which relieves the blockage. So, why is LPI the choice here? Because it directly addresses the mechanical obstruction by creating a new pathway for fluid to flow, preventing the angle from closing again.
Looking at the options, if one of them is LPI, that's the correct one. The other options might include things like medications (beta blockers, miotics) which are used in chronic cases or as adjuncts. But in acute angle closure, the priority is to perform the iridotomy. For example, if an option lists a miotic like pilocarpine, that's incorrect because miotics can actually worsen the angle closure by pulling the iris forward. Topical beta blockers lower pressure but don't open the angle. Surgical options like trabeculectomy are for open-angle glaucoma. So each wrong option needs to be explained based on their mechanism and why they're not suitable here.
The clinical pearl here is that in an acute case, immediate laser or surgical iridotomy is crucial to prevent optic nerve damage. Remembering that LPI is the first-line treatment is key for exams. The correct answer should be the one that mentions laser peripheral iridotomy.
**Core Concept** Angle closure glaucoma occurs when the anterior chamber angle is physically blocked by the iris, obstructing aqueous outflow. The primary treatment goal is to create a patent iridotomy to relieve pupillary block and restore aqueous circulation.
**Why the Correct Answer is Right** Laser peripheral iridotomy (LPI) is the definitive treatment. It uses a YAG laser to create a small hole in the iris, equalizing pressure between anterior and posterior chambers. This relieves the forward bowing of the iris caused by pupillary block, allowing aqueous to flow freely and lowering intraocular pressure (IOP).
**Why Each Wrong Option is Incorrect**
**Option A:** Topical beta-blockers (e.g., timolol) reduce aqueous production but do not address the mechanical angle closure.
**Option B:** Miotics like pilocarpine constrict the pupil, worsening angle closure by pulling the iris forward.
**Option C:** Trabeculectomy is used for open-angle glaucoma, not acute angle closure.
**Clinical Pearl / High-Yield Fact** In acute angle closure glaucoma, never use miotics first—they can worsen the attack. Always prioritize LPI or emergency surgical iridotomy (if laser unavailable) to prevent permanent vision loss.
**Correct Answer: C. Laser peripheral iridotomy**