A 62-year-old woman comes to the emergency department due to acute eye pain. She has a history of seasonal allergies and developed itchy, watery, red eyes after working outdoors in her garden. The patient used over-the-counter eye drops to treat her allergy symptoms, and several hours later, she began experiencing severe right eye pain and headache. On examination, the right eye appears red with a hazy cornea and dilated pupil that responds poorly to light. Palpation of the globes reveals notable firmness on the right compared to the left. Visual acuity in the affected eye is severely diminished. Tonometry reveals elevated intraocular pressure. Which of the following medications was most likely used by this patient?

Question

A 62-year-old woman comes to the emergency department due to acute eye pain.  She has a history of seasonal allergies and developed itchy, watery, red eyes after working outdoors in her garden.  The patient used over-the-counter eye drops to treat her allergy symptoms, and several hours later, she began experiencing severe right eye pain and headache.  On examination, the right eye appears red with a hazy cornea and dilated pupil that responds poorly to light.  Palpation of the globes reveals notable firmness on the right compared to the left.  Visual acuity in the affected eye is severely diminished.  Tonometry reveals elevated intraocular pressure.  Which of the following medications was most likely used by this patient?

Quizplus · Accepted Answer

11ec160b_3c23_99ac_9249_a9eb33a2534b_MD0001_00 This patient is presenting with angle-closure glaucoma (ACG) that was precipitated by use of over-the-counter eye drops. ACG typically occurs in patients with a predisposing narrow chamber angle and develops when the normal drainage pathway of aqueous humor becomes blocked. Aqueous humor is produced by the ciliary body and flows from the posterior chamber of the eye through the pupil into the anterior chamber and out of the eye via the trabecular network. In susceptible individuals, dilation of the pupil causes the iris to press against the anterior surface of the lens. This limits flow of aqueous humor through the pupil, causing the iris to bulge forward. The corresponding reduction (closing) of the iridocorneal angle blocks drainage of aqueous humor through the trabecular meshwork. Acute ACG may be precipitated by topical and systemic medications that cause pupillary dilation, such as alpha-adrenergic agonists (eg, naphazoline) and drugs with strong anticholinergic effects (eg, tricyclic antidepressants, antihistamines). Acute blockage results in a rapid rise in intraocular pressure that typically causes severe eye pain, conjunctival injection, and corneal edema (haziness). If not corrected, the elevated pressure can damage the optic nerve and cause permanent vision impairment. (Choice B) Topical beta blockers (eg, timolol) are used to treat open-angle glaucoma. They work by both reducing the production of aqueous humor and increasing its outflow from the trabecular network. (Choices C and D) Topical mast cell stabilizers (eg, cromolyn, nedocromil) and nonsteroidal anti-inflammatory drugs (eg, ketorolac) are used in the treatment of allergic conjunctivitis, but they are not associated with ACG. (Choice E) Prostaglandin analogues such as latanoprost increase aqueous outflow from the trabecular network and are used in the treatment of open-angle glaucoma. Educational objective: Acute angle-closure glaucoma occurs when the space between the cornea and iris is narrowed, limiting the flow of aqueous humor out of the anterior chamber and raising pressure in the eye. Medications that cause pupillary dilation (eg, alpha-adrenergic agonists, anticholinergics) can trigger acute angle-closure glaucoma. __________ References: The pathophysiology and treatment of glaucoma: a review. (http://www.ncbi.nlm.nih.gov/pubmed/24825645)

A 62-Year-Old Woman Comes to the Emergency Department Due to Acute