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Acute Angle-Closure Glaucoma

Angle-Closure Glaucoma

What is it?
Acute angle-closure glaucoma is a sudden elevation in intraocular pressure that occurs when the iris blocks the eye's drainage channel—the trabecular meshwork. Treatment consists of making a hole in the peripheral iris ("iridotomy") with the laser or surgery. This procedure usually unplugs the outflow mechanism. Click here to watch a narrated video of this process.

This condition affects middle-aged or elderly patients with anatomically small anterior chambers or altered iris structure. Most angle-closure incidents occur spontaneously. Very few cases are precipitated by topical pupil-dilating parasympatholytics, and virtually none by orally administered parasympatholytics—despite the drug insert warnings.

How does it present?
Symptoms of acute angle-closure glaucoma are severe periocular pain, photophobia, and blurred vision. As in keratitis, the conjunctival vessels are most dilated at the corneal edge (ciliary flush, circumcorneal flush). The cornea is often hazy and the pupil unreactive to direct light. Intraocular pressure will be very elevated (above 40 mm Hg).

What to do?
This is an emergency! If the intraocular pressure is not normalized within hours, the optic nerve will die from ischemia. The diagnosis depends on finding elevated intraocular pressure—a tough assignment for physicians who do not habitually perform tonometry. Therefore, refer quickly to an ophthalmologist.

Treatment will consist of administering topical, oral, or intravenous agents to lower intraocular pressure. Once the pressure is lowered, laser or surgical iridotomy will be performed.

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