2ry ACG

1. 1. Peripheral Anterior Synechiae (PAS)
2. Posterior Synechiae
3. Seclusio, Occlusio pupillae
1. Phacomorphic glaucoma (intumescent)
2. Lens subluxation

2. • Red cell glaucoma (OAG)
• Pupil occlusion by blood clot (ACG)
1. IOP lowering agents:
Topical; beta blockers +/- carbonic
anhydrase inhibitors (CAIs)
Systemic; hyper osmotic agents ( mannitol),
&/or CAIs
2. Topical steroids: to reduce inflammation &
risk of 2ry haemorrhage
3. Atropine: is recommended by some
authorities to reduce inflammation & risk of
2ry haemorrhage (clear evidence is lacking)
4. Systemic aminocaproic acid (Kapron):
especially in 2ry haemorrhage

3. Indications for surgical evacuation of hyphaema:
Especially In case of Sickling haemoglobinopathies:
1. IOP > 25 mmHg for 24 hours
2. Repeated IOP spikes > 30 mmHg daily for 2-4 days
3. Corneal staining
4. Any hyphaema failing to resolve less than 50% of AC for 8 days

5. • Vossius Ring
• Ruptured iris sphincter
• High IOP
• Fundus changes typical for glaucoma
• Visual field changes typical for glaucoma
• Initially >> irregularly wide AC angle
• Long standing case >> Closed angle
by fibrosis

6. • SST + MMC
• GDD
• Cyclodestructive therapy e.g. Cyclo photo coagulation, cyclo diode
• if blind painful eye retro-bulbar alcohol, enucleation