acute closed-angle glaucoma

Acute Closed-Angle Glaucoma: A Medical Emergency

Acute closed-angle glaucoma, also known as acute angle-closure glaucoma, is a medical emergency that requires immediate attention. This condition occurs when the drainage system in the eye becomes suddenly blocked, causing a rapid increase in pressure inside the eye.

Symptoms of Acute Closed-Angle Glaucoma

The symptoms of acute closed-angle glaucoma can develop quickly and may include:

• Severe eye pain
• Blurred vision or loss of vision
• Redness of the eye (red eye)
• Nausea and vomiting
• Headache

Causes and Risk Factors

Acute closed-angle glaucoma is caused by a sudden blockage of the drainage system in the eye, which can be triggered by various factors such as:

• A rapid increase in pressure inside the eye
• A sudden change in the shape of the iris or cornea
• A pre-existing narrow angle between the iris and cornea

Diagnosis and Treatment

Diagnosis of acute closed-angle glaucoma is typically made through a combination of clinical examination, measurement of intraocular pressure (IOP), and gonioscopy. Treatment involves immediate medical attention to reduce eye pressure and prevent permanent vision damage.

• References:
  • [1] Acute angle-closure glaucoma comes on quickly and is a medical emergency because permanent vision damage can happen very quickly. Symptoms include severe eye pain, blurred vision, halos, nausea, vomiting and red eye. (Source: #1)
  • [2] It isn’t as common as other types of glaucoma, which cause pressure buildup much more slowly over time. Acute angle-closure glaucoma is caused by a rapid or sudden increase in pressure inside the eye. (Source: #2)
  • [3] In cases of acute angle closure glaucoma, the iris may bow forward so much that it cuts off your eye’s angle completely. Unlike narrow angle glaucoma where some fluid can still drain from the eye, acute angle closure glaucoma does not let any fluid drain. (Source: #4)
  • [5] Acute angle closure is an urgent but uncommon dramatic symptomatic event with blurring of vision, painful red eye, headache, nausea, and vomiting. (Source: #5)

Diagnostic Tests for Acute Closed-Angle Glaucoma

Acute closed-angle glaucoma requires prompt and accurate diagnosis to prevent permanent vision damage. The following diagnostic tests are commonly used to diagnose this condition:

• Gonioscopy: This is a crucial test that allows the doctor to examine the angle between the iris and the cornea, which can become obstructed in acute closed-angle glaucoma [1][2][8]. Gonioscopy may be difficult to perform in the affected eye due to corneal edema [6].
• Measurement of Intraocular Pressure (IOP): High IOP is a key indicator of acute closed-angle glaucoma, and its measurement is essential for diagnosis [4][5][8].
• Corneal Thickness Test: This test measures the thickness of the cornea, which can be affected in acute closed-angle glaucoma.
• Dilated Eye Exam: A thorough examination of the eye, including the retina and optic nerve, may reveal signs of glaucoma.
• Eye Pressure Check: Regular checks of IOP are necessary to monitor the condition and adjust treatment accordingly.
• Optic Nerve Imaging: This test uses imaging technology to visualize the optic nerve and detect any damage caused by glaucoma.
• Visual Field Testing: This test assesses the field of vision and can help identify any defects or blind spots.

In addition to these tests, a dark room prone provocative test may be performed to confirm the existence of an occludable angle [5].

It is essential to note that prompt diagnosis and treatment are critical in preventing permanent vision damage from acute closed-angle glaucoma.

Treatment Options for Acute Closed-Angle Glaucoma

Acute closed-angle glaucoma requires immediate medical attention to prevent permanent vision loss. The primary goal of drug treatment is to rapidly lower the intraocular pressure (IOP) and relieve symptoms.

• Initial Medical Therapy: A combination of medications is typically used to reduce IOP and alleviate symptoms quickly. These may include:
  • Beta-blockers, such as timolol or betaxolol, to decrease aqueous humor production [13].
  • Prostaglandin analogs, like latanoprost or travoprost, to increase outflow of aqueous humor [13].
  • Alpha agonists, such as brimonidine, to reduce IOP and relieve symptoms [13].
• Intravenous Medications: In rare cases, intravenous medications may be administered to rapidly lower IOP. These can include:
  • Mannitol or glycerol to decrease IOP by reducing aqueous humor production.
  • Corticosteroids to reduce inflammation.

It's essential to note that drug treatment is usually the first line of defense in acute closed-angle glaucoma, but it may not be sufficient on its own. In some cases, laser or surgical interventions may also be necessary to address the underlying cause of the condition [7].

References:

• [13] Medical treatment of acute angle-closure glaucoma focuses on rapidly lowering IOP by blocking the production of aqueous humor, increasing the outflow of aqueous humor, and reducing the volume of aqueous humor.
• [7] The two principles of treatment for acute angle closure are swift lowering of intraocular pressure followed by elimination of the pupillary block, if present.

Acute closed-angle glaucoma, also known as acute angle-closure glaucoma, is a medical emergency that requires prompt attention to prevent permanent vision loss.

Possible Causes and Conditions

• Iridocyclitis: Inflammation of the iris and ciliary body can cause pupil constriction, leading to angle closure. [1]
• Pupil block: A condition where the iris is pushed forward, blocking the drainage angle and causing increased intraocular pressure (IOP). [2]
• Lens-induced glaucoma: A condition where a mature or hypermature cataract causes pupil constriction, leading to angle closure. [3]
• Trauma: Head trauma can cause a closed-angle glaucoma by damaging the drainage system of the eye. [4]

Other Conditions that May Present with Similar Symptoms

• Corneal abrasion or foreign body: A corneal injury can cause pain, redness, and blurred vision, which may be mistaken for acute angle-closure glaucoma.
• Conjunctivitis: An infection of the conjunctiva can cause redness, swelling, and discharge, which may be confused with the symptoms of acute angle-closure glaucoma. [5]
• Uveitis: Inflammation of the uvea can cause pain, redness, and vision loss, which may be similar to the symptoms of acute angle-closure glaucoma.

Important Considerations

• A prompt diagnosis is crucial in preventing permanent vision loss.
• The differential diagnosis for acute closed-angle glaucoma includes various conditions that require immediate attention.
• A thorough examination and diagnostic workup are necessary to determine the underlying cause of the symptoms.