›Timolol 0.5 percent one drop
›Apraclonidine 1 percent one drop
›Acetazolamide 500 mg IV or PO
›Pilocarpine 1 to 2 percent one drop after intraocular pressure begins to decrease
›Mannitol IV 1 to 2 g per kg if refractory and no contraindication
›Contraindications
›Beta blocker eye drops with severe asthma or bradycardia
›Acetazolamide caution in severe renal impairment
›Giant cell arteritis vision threat regimen
›Methylprednisolone IV 500 to 1000 mg daily for 3 days
›Transition to oral prednisone 1 mg per kg per day per consultant plan
›Do not delay steroids for imaging or biopsy
›Optic neuritis regimen
›Methylprednisolone IV 1 g daily for 3 to 5 days
›Avoid steroids alone without IV course if demyelinating optic neuritis suspected
›Exclude infection if severe immunocompromise or atypical features
›Central retinal artery occlusion supportive measures
›Emergent ophthalmology consultation
›Stroke protocol dependent reperfusion consideration
›Ocular massage as temporizing measure
›Intraocular pressure lowering measures per ophthalmology
Monitoring and reassessment loop
›Reassessment timing
›Repeat visual acuity and pain score after interventions
›Repeat intraocular pressure after glaucoma therapy
›Repeat neurologic exam for evolving stroke
›Escalation triggers
›Worsening vision
›Increasing pain or corneal clouding
›New neurologic deficits
›Ophthalmology
›Immediate for suspected angle closure
›Immediate for suspected central retinal artery occlusion
›Immediate for suspected retinal detachment with macula on concern
›Neurology or stroke team
›Immediate for suspected stroke or TIA
›Admission pathway coordination
›Rheumatology or internal medicine
›Suspected giant cell arteritis management coordination
›Temporal artery ultrasound or biopsy pathway local protocol dependent