Acute Glaucoma

Acute angle-closure glaucoma has been described rarely after general anesthesia. The disease usually occurs spontaneously and is more common in women and the elderly. Risk factors include a genetic predisposition, shallow anterior chamber, and increased thickness of the lens. The peak incidence of acute glaucoma occurs between the ages of 55 and 65.^[243] Because glaucoma is associated with emotional stress, it is somewhat surprising that it is not seen more often in the perioperative period. Three patient series have been reported. Gartner and Billet described acute angle-closure glaucoma in 4 of 3437 patients (0.1%) who received either general or spinal anesthesia.^[244] Subsequently, Wang and colleagues reported 5 cases in 25,000 surgical patients for an incidence of 0.02%.^[245] The most recent series, which reported the highest incidence, was that of Fazio and coworkers.^[246] These authors reviewed 913 patients who received general or spinal anesthesia and detected nine cases, two of which were bilateral (1%). It is not clear why these authors found such a greater risk than that of previous reports. None of these studies found an association between acute glaucoma and a particular anesthetic technique or drug. Another case after uneventful anesthesia for thyroidectomy in a 66-year-old woman has recently been reported.^[247]

Acute angle-closure glaucoma occurs when the passage of aqueous humor from the posterior to the anterior chamber is obstructed by apposition of the iris to the anterior surface of the lens. The pupil is mid-dilated, with an associated pupillary block. If uncorrected, increased IOP may result in ON damage. The diagnosis should be suspected in patients with a painful red eye and cloudy or blurred vision, possibly accompanied by headache, nausea, and vomiting. This condition is often bilateral. It is distinguished from corneal abrasion, which also produces pain, but without the papillary signs, increased IOP, subjective visual loss, and headache. ^[1] Symptoms may not appear for hours to days after a surgical procedure. Acute glaucoma is an emergency, and ophthalmologic consultation should be obtained immediately. Patients are treated with β-adrenergic antagonists, α-adrenergic agonists, carbonic anhydrase inhibitors, cholinergic agonists, and corticosteroids. Systemic analgesic agents are given as needed. A peripheral iridectomy should be performed later to create a permanent opening between the anterior and posterior chambers.^[243]