Case 3

A nurse in minors asks you to come through and see an 80-year-old man, who has booked in with nausea, vomiting and headache. While he was mobilising to triage, he appeared to bump into several people and appeared to have difficulty sitting down. He states his vision on the right is 'funny'.

What factors in the history would be suggestive of acute angle closure glaucoma (AACG)?

You formally assess his vision with a Snellen chart from six metres away, and he informs you that he can only make out the first, second and third line down the chart, with his right eye.

How would you formally document his visual acuity?

Clinical examination reveals a hard painful globe on the right, with injected sclera and a fixed semi dilated pupil. A diagnosis of acute angle closure glaucoma is confirmed on tonometry and the patient is referred to the ophthalmologist on call.

What treatments could you start in the ED pending ophthalmic review? See if you can list five of them here.