What is the initial management for acute angle-closure glaucoma?

The initial management for acute angle-closure glaucoma focuses on rapidly reducing intraocular pressure and alleviating symptoms. The correct choice involves the use of acetazolamide, which is a carbonic anhydrase inhibitor that decreases the production of aqueous humor, thereby lowering intraocular pressure. The addition of pilocarpine eye drops helps to reverse the pupillary block by inducing miosis (constriction of the pupil) and allowing for better drainage of aqueous humor through the trabecular meshwork, which can further alleviate the elevated intraocular pressure.

This combination is essential in the acute setting to provide immediate relief from the sharp pain, visual disturbance, and potential for optic nerve damage associated with acute angle-closure glaucoma.

The other options do not address the immediate needs as effectively. Timolol, while a useful medication in managing glaucoma, is not the most effective initial treatment in this urgent scenario. Oral steroids do not treat the acute situation and may delay appropriate management. Laser therapy, although an effective long-term solution, is usually reserved for after initial medical intervention has stabilized the patient's condition.