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Angle Closure Glaucoma
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- 3. DEFINITIONClosed-angle glaucomas arecharacterized by a shallow anterior chamber that forces the root of the mid-dilated iris forward against the trabecular network, obstructing the drainage of aqueous humor and thereby increasing the intraocular pressure.Groups at RisksAge >60 yearsGender: females > males (4:1)Race: AsiansFamily history: increased risk with 1st degree relatives
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- 8. PHYSIOLOGICAL PUPILLARY BLOCK1.Iris has large arc of contact with anterior surface of lens2. Resistance to aqueous flow from posterior to anterior chamber (relative pupil block)4. Iris lies against trabecular meshwork  impede aqueous humor drainage  ↑ IOP3. Pupil dilates, peripheral iris becomes more flaccid and pushed anteriorly
- 9. SYMPTOMSRapidly progressive impairmentof visionPainful eyeRed eyeNausea, vomitingPhotophobiaHaloes, transient blurring – indicate previous intermittent attacksHx of similar attacks in the past, aborted by sleep** CACG: usually asymptomatic due to slow onset of disease
- 10. SIGNSReduced visual acuityCorneacloudy and oedematousPupil oval, fixed and moderately dilatedCiliaryinjectionEye feels hard on palpationElevated IOP (50-100 mmHg)Narrow chamber angle with peripheral iridocornealcontactAqueous flare and cellsGonioscopy– complete peripheral iridocornealcontactOphthalmoscopy– optic disc odema and hyperaemia
- 12. ACUTE CONGESTIVE ANGLECLOSURE GLAUCOMADue to rapid ↑ in IOPDefined as:
- 14. Corneal trauma orinfectionAcute congestive glaucomaAcute iridocyclitisAcuteconjunctivitisCommonUncommonCommonExtremely commonIncidenceWatery or purulentNoneNoneModerate to copious (mucopurulent)DischargeUsually blurredMarkedly blurredSlightly blurredNo effect on visionVisionModerate to severeSevereModeratevariablePainDIFFERENTIAL DIAGNOSIS
- 15. DiffuseDiffuseMainly circumcornealDiffuse, moretoward fornicesConjunctival injectionChange in clarity related to causeHazyUsually clearClearCorneaNormalSemidilated and fixedSmallNormal Pupil sizeNormalNonePoorNormalPupillary light responseNormalElevatedNormalNormalIntraocular pressureOrganisms found only in corneal ulcers due to infectionNo organismsNo organismsCausative organismsSmear
- 16. MANAGEMENTEmergency treatment isrequired – preserve the sight!Prevent adhesions of peripheral iris to trabecular meshwork resulting in permanent closure of angleI.V acetazolamide500mg followed by oral acetazolamide 250mg qid after acute attack has brokenTopical beta-blockersTopical steriodsfour times daily to lower the intraocular pressure and decongest the eye
- 18. SURGICAL MANAGEMENTPeripheral laseriridotomy (LPI) (YAG Laser)To establish the communication between the posterior and anterior chambers by making an opening in the peripheral irisThis will be successful only if less than 50% of the angle is closed by permanent peripheral anterior synechiaePeripheral Iridectomy
- 19. CX AND SEQUALAEPeripheralanterior synechiae (PAS) – the peripheral iris adheres to the posterior corneal surface in the trabecular area and blocks the outflow of aqueousCataract- swelling of the lens and cataract formation – this may push the iris even further anteriorly; this increases the pupillary blockAtrophy of the retina and optic nerve - glaucomatous cupping of the optic disc and retinal atrophyAbsolute glaucoma - eye is stony hard, sightless, painful
- 20. SECONDARY ANGLE CLOSUREGLAUCOMAAngle-closure secondary to a variety of ocular disordersLens abnormalities (thick cataract)Lens dislocationInflammation (uveitis, scleritis, extensive retinal photocoagulation)Signs and symptoms Same as PACG
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