Acute angle-closure glaucoma, also known as acute congestive glaucoma, is a common eye disease in the elderly, mostly in women, and often develops in both eyes sequentially or simultaneously. The cause and pathogenesis of acute angle-closure glaucoma is due to a shallow anterior chamber and narrow anterior chamber angle due to the anterior segment of the eye (often combined with hyperopia). In addition, the anterior chamber angle is even narrower due to the increase in age and the thickening of the crystalline lens, and the anterior flow of the atrial fluid is obstructed, which, together with emotional stress and other triggers, leads to a rapid increase in intraocular pressure. Clinical manifestations Patients feel severe eye pain and ipsilateral headache, iris vision, visual blindness, and in severe cases, only a few fingers in front of the eyes or light sensation. Nausea, vomiting, fever, chills, and constipation or diarrhea are often associated. Ocular examination shows elevated intraocular pressure generally ranging from 6.65 to 10.64kl (50-80mmHg). The normal value is 10 to 21 mmHg, and the eye is hard as a stone when measured with the finger. The pupil is dilated, the eye is mixed with congestion, sometimes combined with bulbar conjunctiva and eyelid edema. The cornea is edematous, foggy or grossly glassy, also known as hiatus-like clouding, as if one had breathed into a clear glass in winter. The anterior chamber angle becomes shallow and the angle is occluded, and the atrial fluid is cloudy. Acute attacks that are not controlled can become chronic. If the pressure in the eye continues to rise, it can eventually lead to blindness. In addition, the disease is often prone to misdiagnosis and failure to treat. For example, it is easy to be misdiagnosed as craniosynostosis, migraine, cold, acute gastroenteritis, etc. As long as the eye examination is not neglected, it is not difficult to identify. 2. It is easily misdiagnosed with acute iridocyclitis and acute conjunctivitis. Diagnosis Based on the exclusion of medical diseases, the diagnosis can be made by careful observation of ocular symptoms and signs, and based on the patient’s severe eye pain, headache, rapid decrease in visual acuity, rapid increase in intraocular pressure, finger pressure on the eye as hard as a stone, foggy clouding of the cornea (hairy glass-like or haar-like), oval dilated pupil, and mixed congestion (a dark red white eye). Treatment Acute closed-angle glaucoma may lead to permanent blindness after 24 to 48 hours if not treated in time, therefore, the concept of “rescue” should be used, and the principle of first aid is to lower the intraocular pressure with comprehensive measures. 1.Pupil constrictor Mao Guo Yun Xiang Xiang Yin (Pirocarpin): open the occluded atrial angle, improve the flow of atrial water, thus reducing the intraocular pressure. Commonly used 1%-2% maohuo yunxiangye drops, every 3-5 minutes point 1 time, when the intraocular pressure is reduced or pupil narrowing, according to the intraocular pressure, changed to every 1-2 hours point 1 time, or 3-4 times a day. Use high concentration of frequent eye drops, when dotting the eye, compress the affected tear sac, attention should be paid to the possibility of systemic toxicity. 2.Carbonic anhydrase inhibitors Inhibit atrial aqueous production, thus reducing intraocular pressure, but cannot open the atrial angle. Commonly used is acetazolamide (acetazolamide, acetazolamide, Diamox) 60-90 minutes after taking the drug to start lowering the pressure, 3-5 hours to the lowest point, 8-12 hours back to the level before the drug. Generally the first dose of 500mg is given 2-3 times a day. The drug can cause side effects such as numbness of fingers, toes and scalp, loss of appetite, nausea, urinary tract stones and granulocytopenia. Adrenal cortical insufficiency should be disabled. 3, hypertonic dehydration agents to increase the blood osmolarity, intraocular fluid is leaked and reduce intraocular pressure. (1) 50% glycerol, 50g1, taken at once. The lowering of pressure begins 10 minutes after the drug is administered and is maintained for 4-6 hours. It is prohibited for diabetic patients. (2) 20% mannitol, 250-500 ml, IV drip, 30-60 minutes. After injection 15-30 minutes to start lowering the pressure, 1-2 hours to a low point, 4-6 hours to restore to the level of drug. (3) Patients with irritability and insomnia can be given luminal or hibernate, and constipation can be given as a laxative. (4) The above measures can only temporarily relieve symptoms, but not prevent recurrence, so appropriate surgery should be selected promptly after the IOP is lowered to prevent recurrence.