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chronic closed-angle glaucoma
ICD-10 Codes
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Description
Chronic Closed-Angle Glaucoma: A Gradual and Often Asymptomatic Condition
Chronic closed-angle glaucoma, also known as chronic angle-closure glaucoma, is a type of glaucoma that develops gradually over time. This condition occurs when the drainage channels in the eye (trabecular meshwork) become narrowed or blocked, leading to an increase in intraocular pressure (IOP).
Symptoms May Develop Gradually
Unlike acute angle-closure glaucoma, which can cause sudden and severe symptoms, chronic closed-angle glaucoma may not exhibit any noticeable symptoms at first. As the condition progresses, however, symptoms may develop gradually over time, including:
- A gradual increase in IOP
- Visual field defects (blind spots)
- Gradual loss of vision
Chronic Closed-Angle Glaucoma: A Progressive Condition
If left untreated, chronic closed-angle glaucoma can lead to permanent vision loss and even blindness. This is because the increased pressure on the optic nerve can cause damage over time.
Key Statistics and Facts
- Chronic angle-closure glaucoma occurs when a portion of the angle is intermittently obstructed, resulting in subsequent scarring and narrowing of the angle [4].
- Asymptomatic angle-closure patients present with more severe visual field defects than symptomatic patients [7].
References:
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[4] Context #4
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[6] Not applicable (this information was not provided)
[7] Context #7
Additional Characteristics
- Chronic closed-angle glaucoma is a type of glaucoma that develops gradually over time.
- Symptoms may include: visual field defects, gradual loss of vision
- If left untreated, chronic closed-angle glaucoma can lead to permanent vision loss and even blindness.
Signs and Symptoms
Chronic Closed-Angle Glaucoma: Understanding the Signs and Symptoms
Chronic closed-angle glaucoma, also known as narrow-angle or slow angle-closure glaucoma, is a type of glaucoma that develops gradually over time. In its early stages, it may not cause any noticeable symptoms, making it difficult to diagnose. However, as the condition progresses, various signs and symptoms can appear.
Early Signs and Symptoms:
- No symptoms in the initial stages [2][3]
- Gradual development of symptoms over time [3]
- May result in an episode of acute angle-closure glaucoma or a gradual increase in pressure with possible damage to the optic nerve [3]
Later Signs and Symptoms:
- Severe ocular pain and redness [5]
- Decreased vision, often described as "steamy" vision [6]
- Nausea and vomiting [5][6]
- Rainbow-like halos around lights at night [8]
- Very blurred vision [8]
Other Possible Signs and Symptoms:
- Blurry or unfocused field of vision [7]
- Difficulty adjusting to dark rooms [7]
- Recurring mild pain around or in the eyes [7]
- Recurrent headaches [7]
- Seeing halos around lights, aching eye or brow pain, headache, nausea, vomiting, reduced visual acuity, eye redness, elevated intraocular pressure (IOP), and corneal edema [9]
Important Note:
It's essential to note that chronic closed-angle glaucoma can be asymptomatic in its early stages, making regular eye exams crucial for detection. If you experience any of these symptoms or have a family history of glaucoma, consult an ophthalmologist for proper evaluation and treatment.
References: [1] No reference available [2] Context 2 [3] Context 3 [4] No reference available [5] Context 5 [6] Context 6 [7] Context 7 [8] Context 8 [9] Context 9
Additional Symptoms
- * Nausea and vomiting
- * No symptoms in the initial stages
- * Gradual development of symptoms over time
- * May result in an episode of acute angle-closure glaucoma or a gradual increase in pressure with possible damage to the optic nerve
- * Severe ocular pain and redness
- * Decreased vision, often described as "steamy" vision
- * Rainbow-like halos around lights at night
- * Blurry or unfocused field of vision
- * Difficulty adjusting to dark rooms
- * Recurring mild pain around or in the eyes
- * Recurrent headaches
- * Seeing halos around lights, aching eye or brow pain, headache, nausea, vomiting, reduced visual acuity, eye redness, elevated intraocular pressure (IOP), and corneal edema
- blurred vision
Diagnostic Tests
Diagnostic Tests for Chronic Closed-Angle Glaucoma
Chronic closed-angle glaucoma can be challenging to diagnose, but several tests can help confirm the condition. Here are some diagnostic tests used to detect chronic closed-angle glaucoma:
- Gonioscopy: This is a definitive test for diagnosing angle closure and should be performed on both eyes in all patients suspected of having chronic closed-angle glaucoma [10]. Gonioscopy involves using a special lens to examine the angle between the iris and the cornea, allowing doctors to visualize any blockages or abnormalities.
- Peripheral Anterior Synechiae (PAS) on Gonioscopy: The presence of PAS on gonioscopy is a key indicator of chronic closed-angle glaucoma [6][10]. PAS refers to the adhesion of the iris to the trabecular meshwork, which can lead to increased intraocular pressure.
- Progressive Damage to the Optic Nerve and Characteristic Visual Field Loss: Chronic closed-angle glaucoma is also diagnosed by noting progressive damage to the optic nerve and characteristic visual field loss [10][14].
- Dark Room Prone Provocative Test: This test can be used to confirm the existence of an occludable angle, which is a hallmark of chronic closed-angle glaucoma [9].
It's essential to note that a complete eye exam, including gonioscopy and other diagnostic tests, is necessary to diagnose chronic closed-angle glaucoma accurately. Early detection and treatment can help slow or prevent vision loss.
References:
[6] Context result 6 [9] Context result 9 [10] Context result 10 [14] Context result 14
Additional Diagnostic Tests
- Gonioscopy
- Peripheral Anterior Synechiae (PAS) on Gonioscopy
- Progressive Damage to the Optic Nerve and Characteristic Visual Field Loss
- Dark Room Prone Provocative Test
Treatment
Treatment Options for Chronic Closed-Angle Glaucoma
Chronic closed-angle glaucoma can be treated with various medications to lower intraocular pressure (IOP) and prevent further damage to the optic nerve.
- Medical Therapy: The initial treatment for chronic angle-closure glaucoma is often medical therapy, which includes:
- Beta-blockers: Such as timolol or betaxolol, which reduce IOP by decreasing the production of aqueous humor [5].
- Prostaglandin analogs: Like latanoprost or travoprost, which increase the outflow of aqueous humor and lower IOP [10].
- Alpha agonists: Such as brimonidine, which decrease IOP by reducing the production of aqueous humor and increasing its outflow [5].
- Laser Treatment: Laser peripheral iridotomy (LPI) is a common treatment for chronic angle-closure glaucoma. It involves creating a small hole in the iris to allow fluid to pass from the posterior to the anterior chamber, thereby reducing IOP [6][7].
Important Considerations
It's essential to note that medical therapy alone may not be sufficient to control IOP in all cases of chronic closed-angle glaucoma. In such situations, laser treatment or surgery may be necessary to prevent further damage to the optic nerve.
References
[5] Dec 18, 2013 — Chronic angle-closure glaucoma is treated with therapies to lower intraocular pressure. [6] Definitive treatment is with laser peripheral iridotomy (LPI), which opens another pathway for fluid to pass from the posterior to the anterior chamber, ... [7] Peripheral Iridotomy. This is a laser treatment that creates tiny drainage holes in your iris. It is used to treat both acute and chronic closed-angle glaucoma. [10] The treatment of chronic angle-closure glaucoma is similar to that of open-angle glaucoma. Recently developed procedures to treat chronic angle-closure glaucoma include the Ex-PRESS glaucoma implant, canaloplasty, trabectome, and trabecular micro-bypass stent. [Francis, et al 2011] [1398 Chai CL. 2010]
Recommended Medications
- Beta-blockers
- Alpha agonists
- prostaglandin
💊 Drug information is sourced from ChEBI (Chemical Entities of Biological Interest) database. Always consult with a healthcare professional before starting any medication. Click on any medication name for detailed information.
Differential Diagnosis
Chronic closed-angle glaucoma can be challenging to diagnose, as it shares similar symptoms with other eye conditions. However, there are several key factors that can help differentiate it from other potential causes.
Key Diagnostic Features:
- Peripheral anterior synechiae (PAS) on gonioscopy [3][9]
- Gradual formation of PAS and irreversible iridotrabecular adhesions [7]
- High intraocular pressure (IOP), corneal edema, shallow anterior chamber, and a closed angle on gonioscopy [6]
- Progressive damage to the optic nerve and characteristic visual field loss [11]
Differential Diagnosis:
- Allergic Conjunctivitis
- Bacterial Conjunctivitis (Pink Eye)
- Drug-Induced Glaucoma
- Primary Angle-Closure Glaucoma
Important Considerations:
- In chronic angle closure, angle structures will not be visible for the majority of the angle [15]
- The major mechanisms leading to angle closure include:
- Pupillary block (most common mechanism) [10]
- Other mechanisms such as plateau iris syndrome or anatomical abnormalities
Demographic Considerations:
- Chronic angle-closure glaucoma may be more common than open-angle glaucoma in Asian populations [12]
It's essential to note that a complete eye exam is the only sure way to diagnose chronic closed-angle glaucoma [4]. A glaucoma screening that only checks eye pressure is not sufficient.
References:
[1] Glaucoma: Hone Your Differential Diagnosis... Primary Open Angle Glaucoma [2] Cover Stories: Angle-closure Glaucoma... [3] Chronic angle-closure glaucoma occurs when a portion of the angle is intermittently obstructed, resulting in subsequent scarring and narrowing of the angle further over time. [4] The only sure way to diagnose chronic angle-closure glaucoma is with a complete eye exam. [5] Diagnosis of chronic angle-closure glaucoma is based on the presence of peripheral anterior synechiae on gonioscopy and characteristic optic nerve and visual... [6] Dec 18, 2013 — Diagnosis is made by noting high intraocular pressure (IOP), corneal edema, shallow anterior chamber, and a closed angle on gonioscopy. Medical... [7] Jan 25, 2024 — Chronic angle-closure glaucoma occurs when a portion of the angle is intermittently obstructed, resulting in subsequent scarring and narrowing of the angle further over time. [8] In Asians, the incidence of acute angle-closure seems to be intermediate between those of whites and blacks; however, chronic angle-closure glaucoma may be more common than open-angle glaucoma in this population. In all races, women develop acute angle-closure glaucoma three to four times as often as men. [9] Chronic angle-closure glaucoma is diagnosed by noting peripheral anterior synechiae on gonioscopy, as well as progressive damage to the optic nerve and characteristic visual field loss. [10] The major mechanisms leading to angle closure include: Pupillary block (most common mechanism), other mechanisms such as plateau iris syndrome or anatomical abnormalities. [11] Chronic angle-closure glaucoma is diagnosed by noting peripheral anterior synechiae on gonioscopy, as well as progressive damage to the optic nerve and characteristic visual field loss. [12] In Asians, the incidence of acute angle-closure seems to be intermediate between those of whites and blacks; however, chronic angle-closure glaucoma may be more common than open-angle glaucoma in this population. In all races, women develop acute angle-closure glaucoma three to four times as often as men. [13] Glaucoma is a complex eye condition characterized by elevated intraocular pressure (IOP) that may progress to vision loss over time.
Additional Differential Diagnoses
- Bacterial Conjunctivitis (Pink Eye)
- Drug-Induced Glaucoma
- allergic conjunctivitis
- primary angle-closure glaucoma
Additional Information
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- IAO_0000115
- A primary angle-closure glaucoma characterized by chronic and progressive narrowing of the anterior chamber angle by an intrinsic defect such that aqueous outflow is blocked and the intraocular pressure becomes inappropriately elevated leading to optic nerve damage and visual field loss. Chronic closed-angle glaucoma has_symptom progressive loss of peripheral vision, decreased vision, and occasionally headaches. Chronic closed-angle glaucoma can be caused by anatomically narrow angle, defects in the trabecular meshwork, and iris abnormalities. Primary angle-closure glaucoma has a strong genetic component.
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