Acute Angle-Closure Glaucoma

In acute angle-closure glaucoma, onset of symptoms is usually sudden and is often secondary to rapid pupillary dilation (e.g., after entering a darkened room or after use of anticholinergic or sympathomimetic [mydriatic] ophthalmic medications). Patients may appear systemically ill and report nausea and vomiting, as well as headache and eye pain. Most patients with angle-closure glaucoma are older than 50 years of age.

Causes

• Shallower anterior chambers; anteriorly situated lens; eye length, shorter axial; a thin, floppy iris; and a narrow angle lead to a higher propensity for development of AACG.
• Precipitating factors include drugs, dim light, and rapid correction of hyperglycemia.

Symptoms

• Monocular eye pain usually of sudden onset
• Diffuse blurred vision (almost always)
• Nausea and vomiting secondary to vagal stimulation
• Frontal headache usually of sudden onset
• Colored halos around bright objects

Signs

• Closed angle or a shallow anterior chamber that may be seen by illuminating the iris temporally and failing to see the light reflection on the nasal aspect of the iris
• Corneal haziness or cloudiness almost always seen secondary to corneal edema
• Conjunctival injection
• Fixed mid-dilated pupil (very common)

Treatment

Ophthalmologist must treat angle-closure glaucoma with either laser therapy or surgical therapy. AACG is various include treatment:

• A laser iridotomy is the main and commonly performed procedure. During a laser iridotomy, your eye doctor uses a laser beam to make a hole in the iris to reduce the pressure inside the eye. By making a hole in the iris, the fluid is better able to drain out from the posterior chamber to the anterior chamber of the eye.
• Other situation if the iris cannot be accessed with a laser beam for some reason, a surgical iridectomy is performed, wherein your eye doctor creates the hole in the iris by making surgical incisions.

Prior to a laser iridotomy, your ophthalmologist uses medicines to reduce the pressure inside the eye and to clear up the cloudiness of the cornea that occur during an acute attack of angle-closure glaucoma. Also, because the pupil is often partially dilated, it is constricted before laser surgery.