Select the diuretic that is most effective in acute congestive glaucoma

Angle closure (narrow angle, acute congestive) glaucoma It occurs in individuals with a narrow iridocorneal angle and shallow anterior chamber. The i.o.t.remains normal until an attack is precipitated, usually by mydriasis. The i.o.t. rises rapidly to very high values (40-60 mmHg). It is an emergent condition with marked congestion of eyes and severe headache. Treatment:- 1. Hypeonic mannitol (20%) 1.5-2 g/kg or glycerol (10%): infused i.v. decongest the eye by osmotic action. 2. Acetazolamide:- 0.5 g i.v. followed by oral twice daily is staed concurrently. 3. Miotic:- Once the i.o.t. stas falling due to the above i.v. therapy, pilocarpine 1-4% is instilled every 10 min initially and then at longer intervals. Contraction of sphincter pupillae changes the direction of forces in the iris tolessen its contact with the lens and spreads the iris mass centrally - pupillary block is removed and iridocorneal angle is freed. 4. Topical b blocker:- Timolol 0.5% is instilled 12 hourly in addition. 5. Apraclonidine (1%)/latanoprost 0.005% instillation may be added. Drugs are used only to terminate the attack of angle closure glaucoma. Definitive treatment is surgical or laser iridotomy. Ref:- kd tripathi; pg num:-155,156,157