Rosh Emergency Medicine Practice Test

What is the initial treatment for a patient presenting with signs consistent with acute angle-closure glaucoma?

1. Beta-blocker administration to decrease intraocular pressure

2. Administer intravenous mannitol to reduce ocular pressure

3. Immediate surgical intervention to relieve pressure

4. Oral acetazolamide as the first choice in management

The correct answer is: Administer intravenous mannitol to reduce ocular pressure

In the context of acute angle-closure glaucoma, the initial treatment aims to rapidly reduce intraocular pressure to prevent permanent damage to the optic nerve. The administration of intravenous mannitol is effective because it creates an osmotic gradient that draws fluid out of the eye, thereby lowering the pressure. This rapid decongestive effect is crucial in managing an acute attack, where the risk of vision loss is significant. While other treatments may be useful in a broader management strategy for glaucoma, they do not provide the same immediate and significant reduction in intraocular pressure. Beta-blockers can reduce production of aqueous humor but do not act quickly enough for acute scenarios. Surgical intervention may be necessary but is not the first step in the acute management; instead, it is reserved for when medical treatment fails or is insufficient. Oral acetazolamide can decrease aqueous humor production, but again, it does not provide the prompt response required in emergencies compared to intravenous mannitol.