Douglas J. Rhee, MD

66Note: Medication safety categories from the United States Food and Drug Administration (FDA).Category A: Safety established using human studies.Category B: Presumed safety based on animal studies.Category C: Uncertain safety; no human studies; animal studies show adverse effect.Category D: Unsafe; evidence of risk that in certain clinical circumstances may be justifiable.Category X: Highly unsafe.(3) Acute Angle Closure GlaucomaNotes: 1. Regimen outlined below is once acute angle closure glaucoma secondary to pupillary block has been established.2. Definitive treatment is surgical (i.e., laser iridectomy, surgical iridectomy, etc.)3. Medical treatment is needed to facilitate surgical management.4. Unless contraindicated, we use topical agents (beta blockers, alpha agonists, and carbonic anhydrase inhibitors), systemiccarbonic anhydrase inhibitors (do not use sustained release Diamox Sequels), hyperosmolar agents, and topical steroidsa. Topical Agentsone drop of a beta blocker: timolol maleate or levobunolol 0.5%one drop of an alpha agonist: apraclonidine 1.0% or brimonidine 0.2%one drop of dorzolamide 2% or brinzolamide 1%one drop of prednisolone acetate 1% Q15–30 minutes for four doses then hourlyb. Systemic Agentsone dose of acetazolamide 250–500 mg orally