PDF Angle Closure Glaucoma

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What is acute angle-closure glaucoma?

If you experience any of the symptoms described for primary angle closure, you should seek immediate help from your GP who will refer you to an eye specialist urgently. The condition must be treated quickly. If you are delayed, then go to the Hospital Eye Service urgently.


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If you experience mild attacks where the vision may seem misty, with coloured rings around white lights and there may be some discomfort and redness in the eye, you should consult your optometrist without delay. Acute angle closure is initially treated with drops and an intravenous injection to lower the eye pressure.

Emergency management: angle-closure glaucoma

Normally the same procedure is also performed in the other eye, in order to prevent an attack of acute angle closure in that eye. These treatments are not painful and are usually carried out as an out-patient, although a short stay in hospital may occasionally be required. If primary angle closure is diagnosed and treated without delay there may be an almost complete and permanent restoration of vision.

However, any delay in addressing the problem may result in permanent damage to the affected eye. Occasionally the pressure may remain raised and ongoing treatment will be required, as for POAG. Chronic primary angle closure is treated in a similar way with drops to lower the pressure.

In addition, laser treatment is often given to prevent further angle closure. Primary angle closure glaucoma leaflet.

Emergency management: angle-closure glaucoma

Other treatments, such as tablets, laser therapy and surgery are available, either in place of, or in addition to, eye drops. Laser trabeculoplasty. Cookie Policy We use cookies to provide you with a better service.

Login or Sign-up. Twitter Facebook Linkedin. Primary angle closure acute glaucoma This is a closed angle type of glaucoma, i.

Risks This sort of glaucoma is less common in Western countries and more often found in people of Asian origin. Other risk factors include: Age Acute and chronic angle closure become much more common with increasing age. Instil topical glaucoma medications beta blockers, alpha agonists and prostaglandin analogues. Reduce pain by giving analgesics and reduce inflammation by instilling topical steroids.

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After approximately 1 hour, the decrease in IOP should improve blood supply to the iris and make it more responsive to pilocarpine. If IOP remains dangerously elevated after the second dose of pilocarpine, consider giving hyperosmotic agents such as glycerol, isosorbide or mannitol. Extreme caution is advised in patients with cardiovascular conditions and renal impairment, as the side effects can be life-threatening.

Glycerol is contraindicated in patients with diabetes. Once the patient is stabilised, refer her or him to an ophthalmologist immediately. In other patients, the basis of treatment is an iridotomy: the creation of a hole in the peripheral iris Figure 2 , either surgically or using a laser. This bypasses the pupil block and reestablishes flow from the posterior to the anterior chamber. If the other eye is at risk, iridotomy is performed in both eyes. Put together an acute angle-closure glaucoma emergency kit containing all the medication see panel , 2 needles and syringes that may be needed.

Include a copy of the treatment protocol and the contact details of the nearest ophthalmologist.

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This will ensure that you and your team are prepared. Check expiry dates regularly as this sight-threatening emergency is uncommon. The storage container should be clearly labelled and kept in the emergency room for easy access. Every team member must know where the kit is stored and be familiar with its contents. It is much more rare and is very different from open-angle glaucoma in that the eye pressure usually rises very quickly. This happens when the drainage canals get blocked or covered over, like a sink with something covering the drain.

With angle-closure glaucoma, the iris is not as wide and open as it should be. The outer edge of the iris bunches up over the drainage canals, when the pupil enlarges too much or too quickly. This can happen when entering a dark room. Symptoms of angle-closure glaucoma may include headaches, eye pain, nausea, rainbows around lights at night, and very blurred vision.

Treatment of angle-closure glaucoma usually involves either laser or conventional surgery to remove a small portion of the bunched-up outer edge of the iris. Surgery helps unblock the drainage canals so that the extra fluid can drain. If you have angle-closure glaucoma in one eye, doctors may go ahead and treat the other eye as a safety measure.

In general, surgery for angle-closure glaucoma is successful and long lasting. Regular checkups are still important though, because a chronic form of glaucoma could still occur.