ACUTE ANGLE

CLOSURE GLOUCOMA
 DEFINITION
• AN ATTACK OF ACUTE RISE IN IOP IN PATIENTS WITH
PRIMARY ANGLE CLOSURE MAY OCCUR DUE TO
PUPILLARY BLOCK CAUSING SUDDEN CLOSURE OF
ANGLE.IT DOESN’T USUALLY TERMINATE OF ITS OWN AND
THUS IF NOT TREATED LASTS FOR MANY DAYS.IT IS
ASIGHT THREATENING EMERGENCY .
 SYMPTOMS

• RAPIDLY PROGRESSIVE IMPAIRMENT OF VISION

• RED AND PAINFUL EYE
• NAUSEA ,VOMITING AND PROSTRATIONS
• PHOTOPHOBIA AND LACRIMATION
• COLOURED HALOS AROUND LIGHT ARE GENERALLY SEEN
 SIGNS

• LID BECOMES OEDEMATOUS

• CONJUNCTIVA BECOMES CHEMOSED AND CONGESTED
• CORNEA BECOMES OEDEMATOUS
• AC BECOMES SHALLOW AND AC CELLS AND FLARE MAY BE SEEN IN ANT. CHAMBER
• ANGLE OF ANTERIOR CHAMBER IS COMPLETELY CLOSED AS SEEN IN GONIOSCOPY
• IRIS MAY BE DISCOLOURED
• PUPIL IS SEMIDILATED , VERTICALLY OVAL AND NON REACTIVE TO LIGHT AND ACCOMMODATION
• IOP IS MARKEDLY ELEVATED
• OPTIC DISC IS OEDEMATOUS AND HYPERAEMIC
 DIFFERENTIAL DIAGNOSIS
• ACUTE ANGLE CLOSURE GLAUCOMA IS SOMETIMES CAUSED BY INFLAMED RED EYES LIKE
ACUTE CONJUNCTIVITIS AND ACUTE IRIDOCYCLITIS
• ALSO FROM SECONDARY GLAUCOMAS LIKE
1. PHACOMORPHIC GLAUCOMA : IN THIS THE SWOLLEN LENS PUSHES THE IRIS FORWARD
RESULTING IN SECONDARY ACUTE ANGLE CLOSURE .
2. ACUTE NEOVASCULAR GLAUCOMA : IN THIS THE DEVELOPMENT OF NEW VESSELS OVER IRIS
AND ANGLE OF ANT. CHAMBER OBSTRUCTS AQUEOUS HUMOR OUTFLOW LEADING TO
INCREASED IOP .
3. GLAUCOMATOCYCLITIS CRISIS: ACUTE ,UNILATERAL, RECURRENT ATTACKS OF ELEVATED
IOP ACCOMPANIED BY MILD ANT. CHAMBER INFLAMMATION.
 MANAGEMENT

• IMMEDIATE MEDICAL THERAPY TO LOWER IOP

• DEFINITIVE TREATMENT
• PROPHYLAXIS OF FELLOW EYE
• LONG TERM GLAUCOMA SURVEILLANCE AND IOP MANAGEMENT OF BOTH EYES
 IMMEDIATE MEDICAL THERAPY TO LOWER
IOP
• SYSTEMATIC HYPEROSMOTIC AGENTS FOR LOWERING IOP.
{E.G:MANNITOL(SYSTEMATIC DISEASE SHOULD BE CARED)}
• SYSTEMATIC CARBONIC ANHYDRASE INHIBITORS E.G:ACETAZOLAMIDE 500MG IV STAT
FOLLOWED BY 250 MG TABLET 3 TIMES A DAY.
• TOPICAL ANTI GLAUCOMA DRUGS:
 BETA BLOCKER, 0.5%TIMOLOL OR 0.5% BETAXOLOL
 ALPHA ADERNERGIC AGONISTS , BRIMONIDINE 0.1-0.2%
 PROSTAGLANDIN ANALOGUE, LATANOPROST 0.005%.
 DEFINITIVE THERAPY
• LASER PERIPHERAL IRIDOTOMY: IN THIS A LASER DEVICE IS USED TO CEATE A HOLE IN THE IRIS
AND ALLOWING THE AQUEOUS HUMOR TO TRAVEL DIRECTLY FROM POSTERIOR TO ANT.
CHAMBER AND CONSEQUENTLY , RELIEVE A PUPILLARY BLOCK. HOWEVER IF LASERS ISNOT
AVAILABLE SURGICAL PI SHOULD BE DONE.
• FILTRATION SURGERY (TRABECULECTOMY): IT SHOULD BE PERFORMED IN CASES WHERE IOP IS
NOT CONTROLLED WITH MAXIMUM MEDICAL THERAPY FOLLOWING AN ATTACK OF ACUTE PAC
OR WHEN GONIOSCOPY REVEALS PAS >270º ANGLE .
• MECHANISM : FILTRATION SURGERY PROVIDES AN ALTERNATIVE TO THE ANGLE FOR DRAINAGE OF
AQUEOUS FROM ANTERIOR CHAMBER INTO SUBCONJUNCTIVAL SPACE.

• CLEAR LENS EXTRACTION BY PHACOEMULSIFICATION WITH WITH INTRAOCULAR LENS

IMPLANTATION HAS REALLY BEEN RECOMMENDED BY SOME WORKERS, ESPECIALLY IN THE
PRESENCE OF PHACOMORPHIC ETOLOGY.
PROPHYLACTIC TREATMENT IN THE NORMAL
FELLOW EYE
• PROPHYLACTIC LASER IRIDOTOMY (PREFERABLY) OR SURGICAL PERIPHERAL
IRIDECTOMY SHOULD BE PERFORMED ON THE FELLOW ASYMPTOMATIC EYE
(PACS) AS EARLY AS POSSIBLE AS CHANCES OF ACUTE ATTACK ARE 50% IN SUCH
EYES.
LONG TERM GLAUCOMA SURVEILLANCE AND
IOP MANAGEMENT OF BOTH EYES
• EYES TREATED WITH PI (BOTH AFFECTED AND FELLOW EYE) MAY DEVELOP PACG
AT ANY TIME. SO IT SHOULD BE TREATED AS AND WHEN REQUIRED.
• FILTRATION SURGERY MAY FAIL ANY TIME DURING THE & HENCE NEED TO BE
REPEATED WITH ANTI-METABOLITES.