Which one of the following procedures is most likely to increase intraocular pressure of glaucoma patient –a) Use of atropineb) Decreased pressure in jugular veinc) High dose of vitamin Cd) Dark environmente) Carbonic anhydrase inhibitors.

Any factor which dilates the pupil will precipitate the attack of acute congestive glaucoma. Such factors are dim light (watching a film in a cinema), and mydriatic drugs (atropine, tropicamide, cyclopentolate, phenylephrine). Dilatation of the pupil increases the amount of apposition between iris and anteriorly placed lens with a considerable pressure resulting in relative papillary block. Consequently the aqueous collects in the posterior chamber and pushes the peripheral flaccid iris anteriorly (Iris bombe), resulting in appositional angle closure due to iridocorneal contact. Eventually there occurs a rise in IOP which is transient to begin with but slowly the appositional angle closure is converted to synechial angle closure due to formation of peripheral anterior synechiae (Goniosynechiae). To counteract this, miotic (mainly pilocarpine) is used in the treatment to constrict pupil and pull the iris away from the angle.