How should I initiate treatment for a patient with acute angle-closure glaucoma before referral to secondary care?

Initiate treatment for acute angle-closure glaucoma urgently before referral to secondary care by:

• Administering immediate medical therapy to lower intraocular pressure (IOP), typically including topical beta-blockers, alpha-2 agonists, and systemic carbonic anhydrase inhibitors, unless contraindicated.
• Using miotic agents such as pilocarpine cautiously once IOP is lowered to open the angle.
• Providing analgesia and antiemetics as needed to manage symptoms.
• Arranging urgent referral to ophthalmology for definitive treatment, such as laser peripheral iridotomy.

Ensure no contraindications or drug interactions exist before starting pharmacological treatment and consider the patient's cognitive and physical status when managing treatment.

This approach aligns with the NICE guideline emphasis on urgent management and referral for angle-closure glaucoma to prevent sight loss, although the detailed acute management steps are standard clinical practice supported by the guideline's focus on timely referral and treatment initiation.