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Angle-Closure Glaucoma by Diana Kohnle

Definition

Glaucoma represents a group of eye disorders that cause damage to the optic nerve. Glaucoma is a degenerative eye disease and one of the leading causes of blindness in the United States.

Angle-closure glaucoma is a condition in which the iris in the eye shifts and blocks the exit passageway of the aqueous humor, the fluid that fills the eye. This fluid blockage causes a rapid build-up of pressure in the eye.

Angle-closure glaucoma is an emergency condition that requires immediate medical treatment to preserve vision.

Glaucoma

Causes

The exact cause of open-angle glaucoma is unknown. However, factors that play a role in causing the disease include:

Narrowing of the drainage angle in the eye—Aging and being farsighted are two causes of this narrowing.
Being born with narrow angles
Injury to the eye

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. The following factors increase your chance of developing angle-closure glaucoma:

Family history of narrow angle glaucoma
Glaucoma in one eye—This increases the risk of developing glaucoma in the other eye.
Ethnic background—Asians are at greater risk of angle-closure glaucoma.
Injury to the eye
Eye drops used to dilate the eyes
Certain systemic medications

Symptoms

Patients with narrow angles experience few or no symptoms until the disease has progressed to an acute angle-closure attack. Symptoms of this may include:

Severe pain in the eye
Facial pain
Pupil not reacting to light
Blurred or cloudy vision
Nausea
Vomiting
Redness and swelling of the eye

Diagnosis

Your doctor will ask about your symptoms and medical history, and perform a physical exam.

Tests may include the following:

Eye exam
Tonometry —to determine intraocular pressure
Slit lamp examination—the use of a low-power microscope combined with a high-intensity light source, allows a narrow beam that can be focused to examine the front of the eye
Gonioscopy—the use of a special mirror to view the drainage angle of the eye

Treatment

Angle-closure glaucoma requires emergency medical treatment to preserve vision. See an ophthalmologist immediately if you have any signs or symptoms of an angle-closure glaucoma attack. Treatment options include:

Medications—Eye drops, pills, and sometimes even intravenous drugs are often administered to reduce intraocular pressure.
Surgery—Surgery (usually done by laser) may be used to stop or prevent an attack of angle-closure glaucoma.

Prevention

Angle-closure glaucoma cannot be prevented, but prompt medical treatment can reduce the risk of vision loss. Patients at high risk of having an angle-closure glaucoma attack may undergo preventive surgery to open a new channel in the iris. Since you can’t tell if you have narrow angles, it is important to have a comprehensive eye examination regularly.

RESOURCES:

The Glaucoma Foundation http://www.glaucomafoundation.org/
Glaucoma Research Foundation http://www.glaucoma.org/index.php
St. Luke's Eye Cataract & Laser Institute http://www.stlukeseye.com/

CANADIAN RESOURCES:

Glaucoma Canada http://www.glaucomacanada.com/
Glaucoma Research Society of Canada http://www.glaucomaresearch.ca/

References:

Acute glaucoma (primary angle closure glaucoma). International Glaucoma Association website. Available at: http://www.glaucoma-association.com/nqcontent.cfm?a_id=714&=fromcfc&tt=article&lang=en&site_id=483 . Accessed July 16, 2007.
Blindness. World Health Organization website. Available at: http://www.who.int/topics/blindness/en/ .
Glaucoma. Medline Plus Medical Encyclopedia. US National Library of Medicine website. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/001620.htm . Accessed June 27, 2007.
Glaucoma. US National Institutes of Health. National Eye Institute website. Available at: http://www.nei.nih.gov/health/glaucoma/glaucoma_facts.asp . Accessed June 27, 2007.
Spaeth G. What is angle closure glaucoma? Glaucoma Service Foundation to Prevent Blindness website. Available at: http://wills-glaucoma.org/aclose.htm . Accessed June 27, 2007.

Last reviewed September 2009 by Christopher Cheyer, MD

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