Optic nerve damage might occur due to the increased IOP also, either in a sudden assault or in intermittent episodes over a long time period. Sometimes, the attack could be caused by dilation of the pupils, possibly during an eye examination. In eye that are smaller anatomically, pupillary block may occur, causing acute angle closure glaucoma. In pupillary block, a short episode of obstruction of aqueous fluid may appear by the pupil coming into connection with the structures behind it, usually the zoom lens of the eye. This causes the pressure of the fluid behind the iris to become greater than the pressure of fluid in front of the iris , leading to the iris to become pushed forwards, initiating closure of the position. Acute angle closure glaucoma may be primary or secondary. In primary acute angle closure glaucoma, there is absolutely no underlying eye disease that’s causing the condition.Sinh, M.D., Van A. Duong, B.Sc., Thu N. Hoang, M.Sc., Pham T. Diep, B.Sc., James I. Campbell, M.I.B.M.S., Tran P.M. Sieu, M.D., Stephen G. Baker, Ph.D., Nguyen V.V. Chau, M.D., Ph.D., Tran T. Hien, M.D., Ph.D., David G. Lalloo, M.D., and Jeremy J. Farrar, M.D., D.Phil.: Mixture Antifungal Therapy for Cryptococcal Meningitis There are 1 million cases of cryptococcal meningitis yearly and 625 around,000 deaths.1 Treatment guidelines recommend induction therapy with amphotericin B deoxycholate and flucytosine .2 However, this treatment is not shown to reduce mortality, in comparison with amphotericin B monotherapy.2,3 Flucytosine is frequently unavailable where in fact the disease burden is best, and concerns about side and cost effects have limited its use in resource-poor settings.4 Fluconazole is readily available, is connected with low rates of adverse events, and has good penetration into cerebrospinal liquid , nonetheless it is connected with poor outcomes when used while monotherapy for cryptococcal meningitis.2 Its security profile, low priced, and availability make it an attractive option to flucytosine for mixture therapy with amphotericin B, and it is recommended as an alternative in the rules.2 However, when this combination was used in conventional doses , it didn’t improve the rate of yeast clearance from the CSF, in a report not powered for medical end points.5 Increased doses of amphotericin B and fluconazole independently result in improved rates of yeast clearance.6,7 To our understanding, these increased doses have not been tested in mixture.8 In Asia, many individuals receive treatment with amphotericin B monotherapy for 2 to 4 weeks, accompanied by fluconazole at a dose of 400 mg per day before end of week 10.