angle-closure glaucoma

What is Angle-Closure Glaucoma?

Angle-closure glaucoma, also known as closed-angle glaucoma or narrow-angle glaucoma, is a medical emergency that occurs when the drainage system in the eye becomes blocked, causing a rapid increase in intraocular pressure (IOP). This can lead to permanent vision damage if not treated promptly.

Causes and Symptoms

The iris can bulge forward, blocking the drainage angle and preventing fluid from draining out of the eye. This can happen suddenly or gradually, and symptoms may include:

• Severe eye pain
• Blurred vision
• Halos around lights
• Nausea and vomiting
• Red eye

Types of Angle-Closure Glaucoma

There are two main types: acute angle-closure glaucoma, which comes on quickly, and chronic angle-closure glaucoma, which develops slowly over time.

Prevention and Treatment

The best way to prevent an acute angle closure glaucoma attack is to get your eyes checked regularly, especially if you're at high risk. Treatment typically involves medications or surgery to lower IOP and restore drainage in the eye.

Statistics and Prevalence

Angle-closure glaucoma is a major cause of blindness worldwide, with a particularly high prevalence in certain populations. It's essential to be aware of the risks and take preventive measures to protect your vision.

References:

• [1] Closed angle glaucoma occurs when your iris and cornea move toward each other, closing the anterior angle between them. When the angle is closed, it blocks the drainage of aqueous humor, leading to a rapid increase in IOP.
• [2] Acute angle-closure glaucoma is an ocular emergency that results from a rapid increase in intraocular pressure due to outflow obstruction of aqueous humor.
• [3] Angle-closure glaucoma (also called “closed-angle glaucoma” or “narrow-angle glaucoma”) This type happens when someone’s iris is very close to the drainage angle in their eye. The iris can end up blocking the drainage angle.
• [4] Glaucoma is a complex eye condition characterized by elevated intraocular pressure (IOP) that may progress to vision loss over time.

Symptoms of Angle-Closure Glaucoma

Angle-closure glaucoma is a medical emergency that requires prompt attention. The symptoms can be severe and sudden, making it essential to recognize them early on.

• Severe Eye Pain: A sharp, stabbing pain in one eye is often the first symptom of angle-closure glaucoma [1].
• Redness: The affected eye may become red, swollen, and inflamed due to increased pressure [2].
• Vision Loss: Sudden vision loss or blurred vision can occur, which can be temporary or permanent if left untreated [3].
• Seeing Rainbow-Colored Rings Around Lights or Halos: A rainbow-colored ring or halo around lights is a common symptom of angle-closure glaucoma [4].
• Headache and Nausea: Severe headaches and nausea are also symptoms of this condition, which can be accompanied by vomiting [5].

Early Warning Signs

In some cases, patients may experience mild symptoms before an acute attack, including:

• Intermittent Headaches and Eye Pain
• Halos Around Lights
• Blurred Vision

It is crucial to seek medical attention immediately if you or someone you know experiences any of these symptoms. Early detection and treatment can help prevent permanent vision loss.

References:

[1] Context 3, [4], [7] [2] Context 4 [3] Context 5, [12] [4] Context 1, [8] [5] Context 3

Diagnostic Tests for Angle-Closure Glaucoma

Angle-closure glaucoma is a medical emergency that requires prompt diagnosis and treatment to prevent permanent vision damage. The following diagnostic tests are used to confirm the presence of angle-closure glaucoma:

• Gonioscopy: This is a definitive test for diagnosing angle closure, where an ophthalmologist uses a special lens to examine the angle between the iris and cornea. Gonioscopy should be performed on both eyes in patients suspected of having angle closure (Source: [6], [9], [10])
• Intraocular Pressure (IOP) measurement: Measuring IOP is crucial in diagnosing acute angle-closure glaucoma, as high pressure can indicate outflow obstruction of aqueous humor (Source: [1], [12])
• Corneal edema and shallow anterior chamber examination: Examination of the cornea and anterior chamber can reveal signs of angle closure, such as corneal edema and a shallow anterior chamber (Source: [8], [14])
• Dark room prone provocative test: This test is used to confirm the existence of an occludable angle by measuring IOP in a dark room while the patient is prone (Source: [5])

These diagnostic tests are essential for confirming the presence of angle-closure glaucoma and guiding treatment decisions. Early diagnosis and treatment can help prevent permanent vision damage.

References:

[1] Context result 1 [5] Context result 5 [6] Context result 6 [8] Context result 8 [9] Context result 9 [10] Context result 10 [12] Context result 12

Treatment Options for Angle-Closure Glaucoma

Angle-closure glaucoma can be treated with various medications, which are often used in conjunction with other treatments such as laser or surgery.

• Medications: Initially, acute angle closure glaucoma is treated with a range of medicines that may be given as eye-drops or pills [3]. These medications work to lower intraocular pressure (IOP) and reduce the risk of damage to the optic nerve.
• Intravenous Medications: In rare cases, intravenous medications may be used to quickly lower IOP in severe cases of angle-closure glaucoma [3].
• Therapies for Chronic Angle-Closure Glaucoma: For chronic forms of angle-closure glaucoma, therapies are focused on lowering intraocular pressure. This can involve a combination of eye drops and/or pills [2].

Key Factors to Consider

It's essential to note that definitive treatment for acute angle-closure glaucoma is often laser peripheral iridotomy (LPI), which opens another pathway for fluid to pass from the posterior to the anterior chamber, reducing IOP [5]. However, medications may be used as a temporary measure or in conjunction with other treatments.

References

• [1] Treatment for non-acute angle-closure glaucoma​​ Your provider is likely to treat non-acute forms of angle-closure glaucoma with laser iridotomy.
• [2] Dec 18, 2013 — Chronic angle-closure glaucoma is treated with therapies to lower intraocular pressure. History and Exam.
• [3] Initially, acute angle closure glaucoma is treated with a range of medicines that may be given as eye-drops or pills. In rare cases intravenous medications may ...
• [4] May 3, 2021 — The treatment of acute angle-closure glaucoma (AACG) consists of IOP reduction, suppression of inflammation, and the reversal of angle closure.
• [5] Definitive treatment is with laser peripheral iridotomy (LPI), which opens another pathway for fluid to pass from the posterior to the anterior chamber, ...
• [6] Surgical iridectomy has since been a cornerstone of management of angle-closure glaucoma until the mid 1970's when it was superseded by laser peripheral.

Differential Diagnosis of Angle-Closure Glaucoma

Angle-closure glaucoma is a medical emergency that requires prompt diagnosis and treatment to prevent permanent vision loss. The differential diagnosis for angle-closure glaucoma includes several conditions that can present with similar symptoms, making it essential to consider these differentials in the diagnostic process.

Conditions to Consider:

• Open-angle glaucoma: This is the most common type of glaucoma and is characterized by a slow increase in intraocular pressure (IOP) due to impaired drainage of aqueous humor. While open-angle glaucoma is typically a chronic condition, it can present with acute symptoms similar to angle-closure glaucoma [1].
• Retrobulbar hemorrhage or inflammation: This condition involves bleeding or inflammation behind the eye and can cause increased IOP, corneal edema, and shallow anterior chamber, which are similar to the findings in angle-closure glaucoma [2].
• Traumatic (hemolytic) glaucoma: This is a rare type of glaucoma caused by trauma to the eye, leading to increased IOP and potential damage to the optic nerve. The symptoms can be similar to those of angle-closure glaucoma [3].
• Glaucomatocyclitic crisis (GTC): This is a rare condition characterized by recurrent episodes of increased IOP, corneal edema, and shallow anterior chamber, which can mimic the presentation of angle-closure glaucoma [4].

Other Considerations:

• Primary angle closure may be caused by pupillary block or angle crowding or both: Pupillary block occurs when the increased iris convexity blocks the drainage of aqueous humor, leading to increased IOP and potential angle closure. Angle crowding refers to a narrow anterior chamber due to anatomical factors [5].
• Other optic neuropathies (e.g., compressive): These conditions can cause damage to the optic nerve and may present with similar symptoms to angle-closure glaucoma, including vision loss and increased IOP [6].

References:

[1] Context 4 [2] Context 5 [3] Context 5 [4] Context 5 [5] Context 7 [6] Context 8