What is the typical treatment for severe, sudden unilateral ocular pain with vision changes?

The typical treatment for severe, sudden unilateral ocular pain with vision changes, particularly in the context of conditions like acute glaucoma, is acetazolamide. This medication is a carbonic anhydrase inhibitor that reduces the production of aqueous humor, effectively lowering intraocular pressure. In the case of acute angle-closure glaucoma, where pain is associated with a rapid increase in intraocular pressure, acetazolamide plays a crucial role in providing relief by decreasing fluid accumulation in the eye.

Pilocarpine drops, while useful in treating certain types of glaucoma by increasing outflow of aqueous humor, are not the first-line treatment in acute cases where pressure needs to be reduced rapidly. IV steroids would be indicated in cases of inflammatory conditions affecting the eye but are not typically used for acute intraocular pressure issues. Topical anesthetics, while they may provide temporary relief of pain, do not address the underlying issues or the pathophysiology of severe ocular conditions. Thus, the choice of acetazolamide aligns best with the needs of the patient presenting with such symptoms.