Closed Angle Glaucoma
Definition
Glaucoma: Disease causing death of optic nerve
Close angle: ACUTE blockage of ALL of trabecular meshwork in anterior chamber
NOTE: High intraocular pressure (IOP) is not required for diagnosis
Risk Factors
Pathophysiology
Pupillary block:
Lens plasters up against the back of the iris --> blocking aqueous flow through the pupil --> Pressure gradient --> iris and lens move anteriorly --> Irido-corneal angle closes --> Blocks the trabecular meshwork --> aqueous fluid builds up --> eye pressure increases rapidly --> Optic nerve is damaged from stretching and decreased blood supply
Clinical Features
Symptoms
Signs
Management
Medical:
Surgery:
Source
Dr Tim Root, www.ophtobook.com, 2009
Glaucoma: Disease causing death of optic nerve
Close angle: ACUTE blockage of ALL of trabecular meshwork in anterior chamber
NOTE: High intraocular pressure (IOP) is not required for diagnosis
Risk Factors
- Hyperopes (small eyes)
- Asians
- Antihistamines/ cold meds (causes pupil dilation --> close angle)
Pathophysiology
Pupillary block:
Lens plasters up against the back of the iris --> blocking aqueous flow through the pupil --> Pressure gradient --> iris and lens move anteriorly --> Irido-corneal angle closes --> Blocks the trabecular meshwork --> aqueous fluid builds up --> eye pressure increases rapidly --> Optic nerve is damaged from stretching and decreased blood supply
Clinical Features
Symptoms
- Injected painful eye(s)
- N+v
- Halo around lights (oedema of cornea)
Signs
- Shadow from lateral penlight (shallow chamber)
- Gonioscope: closed angle
- Inc IOP
- Hazy cornea
- Mid-dilated/ oval pupils
- RAPD
Management
Medical:
- Many meds at once
- BB
- Prostaglandin analogues
- CAI (Diamox)
- IV mannitol/ glycerin (osmotics)
- Pilocarpine (pupil constriction - miosis)
Surgery:
- Laser iridotomy (communication between ant/ post chamber)
Source
Dr Tim Root, www.ophtobook.com, 2009