A 66-year-old woman with a history of hypertension and allergy to “sulfa” complains of acute onset of left eye pain, headache, and vomiting. She has photophobia. Her eye is pictured below (Figure 6-1). Her intraocular pressure (IOP) is 60 mm Hg. What medication is contraindicated?
The proper management of acute angle glaucoma is intravenous analgesics, antiemetics, mannitol and acetazolamide, topical beta-blockers, and steroids to lower IOP, followed by a miotic. However, in this patient, acetazolamide is contraindicated with her allergy to sulfonamides. Miotics (pupillary constrictors) not mydriatics (pupillary dilators) are effective when the IOP has been brought under control by the other measures and pull the iris away from the cornea to avoid recurrence. There is no role of antibiotics. Emergent ophthalmic consultation is needed for definitive treatment.