What are the signs of angle closure glaucoma. How is narrow angle glaucoma diagnosed. What treatments are available for acute angle closure glaucoma. Why is regular eye pressure monitoring important for glaucoma patients.

Understanding Angle Closure Glaucoma: A Silent Threat to Vision

Angle closure glaucoma, also known as narrow-angle glaucoma or closed-angle glaucoma, is a serious eye condition that can lead to rapid vision loss if left untreated. This type of glaucoma occurs when the drainage angle between the iris and cornea becomes blocked, causing a sudden increase in intraocular pressure (IOP). Unlike the more common open-angle glaucoma, angle closure glaucoma can develop quickly and requires immediate medical attention.

What causes angle closure glaucoma?

The primary cause of angle closure glaucoma is the blockage of the eye’s drainage system. This blockage prevents the aqueous humor, the clear fluid that fills the front part of the eye, from draining properly. As a result, pressure builds up within the eye, potentially damaging the optic nerve and leading to vision loss.

Recognizing the Symptoms of Angle Closure Glaucoma

Identifying the symptoms of angle closure glaucoma is crucial for early detection and treatment. While some people may experience a gradual onset of symptoms, others may face a sudden attack that requires immediate medical intervention.

What are the common symptoms of angle closure glaucoma?

• Severe eye pain
• Sudden onset of blurred vision
• Headache, often severe and accompanied by nausea
• Redness in the eye
• Halos or rainbow-colored rings around lights
• Sudden loss of vision in one or both eyes
• Nausea and vomiting
• Mid-dilated pupil that doesn’t respond to light

These symptoms can occur rapidly and may be more noticeable in the evening or in low-light conditions when the pupil naturally dilates.

Types of Angle Closure Glaucoma: Acute vs. Chronic

Angle closure glaucoma can be categorized into two main types: acute and chronic. Understanding the differences between these types is essential for proper diagnosis and treatment.

What is acute angle closure glaucoma?

Acute angle closure glaucoma is a medical emergency characterized by a sudden and severe increase in intraocular pressure. This type develops rapidly and requires immediate treatment to prevent permanent vision loss. Symptoms of acute angle closure glaucoma often appear suddenly and may include intense eye pain, headache, nausea, and blurred vision.

How does chronic angle closure glaucoma differ?

Chronic angle closure glaucoma develops more slowly over time. In this type, the drainage angle narrows gradually, leading to a slow increase in eye pressure. Symptoms may be less noticeable and can develop over months or years. Regular eye exams are crucial for detecting chronic angle closure glaucoma before significant vision loss occurs.

Diagnosing Angle Closure Glaucoma: The Importance of Regular Eye Exams

Early detection of angle closure glaucoma is vital for preventing vision loss. Regular comprehensive eye exams play a crucial role in identifying the condition before symptoms become severe.

What tests are used to diagnose angle closure glaucoma?

1. Tonometry: Measures intraocular pressure
2. Gonioscopy: Examines the drainage angle of the eye
3. Ophthalmoscopy: Evaluates the optic nerve for signs of damage
4. Visual field test: Assesses peripheral vision
5. Optical coherence tomography (OCT): Provides detailed images of the optic nerve and retina

These tests help eye care professionals determine the type and severity of glaucoma, guiding treatment decisions and monitoring the progression of the disease.

Treatment Options for Angle Closure Glaucoma

The primary goal of angle closure glaucoma treatment is to reduce intraocular pressure and prevent further damage to the optic nerve. Treatment options vary depending on the type and severity of the condition.

What are the immediate treatments for acute angle closure glaucoma?

• Medications to lower eye pressure (eye drops, oral medications)
• Laser therapy (peripheral iridotomy) to create a small hole in the iris, allowing fluid to drain
• Surgical intervention in severe cases

How is chronic angle closure glaucoma managed?

Chronic angle closure glaucoma may be managed with a combination of treatments, including:

• Prescription eye drops to reduce intraocular pressure
• Laser treatments to improve drainage
• Surgical procedures to create new drainage channels
• Regular monitoring and follow-up appointments

Risk Factors and Prevention of Angle Closure Glaucoma

While anyone can develop angle closure glaucoma, certain factors may increase the risk. Understanding these risk factors can help individuals take proactive steps to protect their vision.

Who is at higher risk for angle closure glaucoma?

• People over the age of 40
• Women (more commonly affected than men)
• Individuals of Asian or Inuit descent
• Those with a family history of glaucoma
• People with farsightedness
• Individuals with certain eye conditions (e.g., cataracts, eye tumors)

Can angle closure glaucoma be prevented?

While it may not be possible to prevent angle closure glaucoma entirely, regular eye exams can help detect the condition early. Additionally, maintaining a healthy lifestyle, managing other health conditions, and avoiding certain medications that can dilate the pupils may reduce the risk of an acute attack.

Living with Angle Closure Glaucoma: Long-term Management and Outlook

Managing angle closure glaucoma is an ongoing process that requires commitment from both the patient and their healthcare team. With proper treatment and regular monitoring, many individuals with angle closure glaucoma can maintain good vision and quality of life.

What lifestyle changes can help manage angle closure glaucoma?

• Adhering to prescribed medication regimens
• Attending regular follow-up appointments
• Maintaining a healthy diet rich in eye-friendly nutrients
• Exercising regularly to promote overall health
• Protecting eyes from injury and excessive UV exposure
• Quitting smoking and limiting alcohol consumption

What is the long-term outlook for patients with angle closure glaucoma?

The prognosis for angle closure glaucoma varies depending on how early the condition is detected and how well it is managed. With timely treatment and ongoing care, many patients can preserve their vision and prevent further damage. However, any vision loss that occurs before treatment is typically irreversible, highlighting the importance of early detection and intervention.

Advancements in Angle Closure Glaucoma Research and Treatment

The field of glaucoma research is continually evolving, with new treatments and diagnostic tools emerging to improve patient outcomes. Staying informed about these advancements can provide hope and new options for those affected by angle closure glaucoma.

What are some recent developments in angle closure glaucoma treatment?

• Minimally invasive glaucoma surgery (MIGS) techniques
• Advanced imaging technologies for earlier detection
• Gene therapy research for potential future treatments
• Development of sustained-release medication delivery systems
• Artificial intelligence applications in glaucoma diagnosis and monitoring

These advancements offer promising possibilities for improving the diagnosis, treatment, and management of angle closure glaucoma in the future.

Angle closure glaucoma remains a significant threat to vision worldwide, but with increased awareness, regular eye exams, and ongoing research, the outlook for those affected by this condition continues to improve. By understanding the symptoms, risk factors, and treatment options available, individuals can take proactive steps to protect their vision and maintain their quality of life. Remember, early detection and prompt treatment are key to preserving sight in the face of this challenging eye disease.

What Is Narrow Angle Glaucoma?

Dr. Russel Lazarus, October 6, 2021

Glaucoma is the #1 preventable cause of vision loss.

What is glaucoma?

Glaucoma is an eye disease that causes vision loss from damage to the optic nerve, which is responsible for carrying visual signals between the eye and brain.

• Glaucoma is the #1 cause of irreversible blindness, worldwide.
• Glaucoma accounts for 12.3% of global blindness.
• Glaucoma affects up to 5% of the people aged 70+ years and increases to over 9% for those aged 80+ years.

The most common form of glaucoma occurs when there is high pressure inside the eye (intraocular pressure, IOP), caused by a build-up of fluid that cannot drain properly.

Glaucoma: the ‘Silent Thief of Sight’

This nickname is well deserved as glaucoma causes vision loss before most people notice any symptoms.   

Glaucoma has the infamous reputation of “robbing” eyesight, without giving the person time to recognize symptoms and seek their eye doctor’s medical opinion.

Consequently, a diagnosis of glaucoma is too often made too late, and only after permanent vision loss has occurred.

It is therefore important to schedule regular eye exams, as new diagnostic tests are available to detect early signs of glaucoma, and are essential in preventing vision loss.

What is narrow-angle glaucoma (NAG)?

Narrow-angle glaucoma is a type of glaucoma that develops suddenly and can lead to sudden and permanent loss of sight.

Narrow-angle glaucoma is the cause of less than 10% of all glaucoma diagnosis, but can cause immense pain and sudden loss of sight and even blindness.

This condition is also known as ‘acute angle-closure glaucoma’ or ‘closed-angle glaucoma’ and occurs when the drainage angle, a structure inside the eye that permits fluid to drain normally from the eye, becomes blocked.

The resulting fluid buildup can cause an abrupt, severe increase in intraocular pressure (IOP) that may result in immediate damage to the optic nerve.

SEE RELATED: What is Glaucoma?

Contact an eye doctor near you if you have any concerns about your vision or eye health

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Types of narrow-angle glaucoma

There are two forms of narrow-angle glaucoma: acute and chronic.

1. Acute NAG

Acute NAG is a term that refers to the sudden closing of the drainage angle. When the usual passage of aqueous humor between the iris and the lens is suddenly and immediately interrupted, this form of glaucoma develops.

2. Chronic NAG

Chronic NAG is also due to a narrowed drainage angle, but this form develops slowly and can cause damage gradually over a period of time, often without obvious symptoms.

Symptoms of narrow-angle glaucoma

Most people will experience the following symptoms since their eye pressure rises dramatically in a short period of time:

• Nausea
• Eye pain
• Red eyes
• Headache
• Blurred vision
• Mid-dilated pupil
• Halos around lights
• Sudden loss of vision
• Sudden severe eye and head pain

LEARN MORE: Guide to Eye Conditions

Schedule an eye exam with an eye doctor near you who can diagnose if you have narrow-angle glaucoma.

It’s easy to become concerned when you learn about narrow-angle glaucoma’s fast onset and serious consequences. 

Fortunately, a comprehensive eye exam can diagnose the condition, and it can be treated with a range of successful treatments. The sooner any type of glaucoma is diagnosed and treated, the lower the risks of vision loss. 

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Symptoms and How To Treat Them

Are you worried about the possibility of developing Closed Angle Glaucoma? This is one of the most common types of glaucoma, and it can cause serious loss of vision if left untreated. In this article, we will discuss the symptoms of acute angle-closure glaucoma, how to measure eye pressure, and what treatments are available for those suffering from this condition. We will also explore the potential risks associated with surgical treatment for closed-angle glaucoma.

What is Closed Angle Glaucoma?

Narrow-angle glaucoma is a type of eye disease that occurs when the drainage angle between the iris and cornea becomes blocked. This blockage causes an increase in eye pressure, damaging the optic nerve at the back of the eye, which can lead to blurred vision, eye pain, and other severe symptoms. It is one of two types of glaucoma, the other being open-angle glaucoma.

People with closed-angle glaucoma are more likely to have high blood pressure than those with open-angle glaucoma. Acute closed-angle glaucoma is a medical emergency that requires immediate treatment to prevent permanent vision loss or other eye disorders.

Signs and Symptoms of Closed Angle Glaucoma

It is important to be aware of the signs and symptoms of this condition so that it can be treated as soon as possible.

• Blurred vision
• Eye pain
• Headache
• Nausea and vomiting
• Halos around lights
• Redness in the eye
• A sudden increase in pressure in the eyes
• Tunnel vision
• Difficulty seeing in dim light
• Eye discomfort or pain
• Seeing rainbow-colored circles around lights
• Increased sensitivity to light
• Excessive tearing of the eyes
• Swelling of the eyelids or face
• Unusual eye movements
• A feeling of pressure in the eye
• Family history of glaucoma
• Gradual loss of peripheral vision

If you experience any of these symptoms or suspect that you may have closed-angle glaucoma, it is important to seek medical attention immediately.

Treatment Options for Closed-Angle Glaucoma

Closed-angle glaucoma is a serious medical condition that can lead to vision loss if left untreated. Treatment for this condition typically involves surgical therapy, which can involve various types of surgeries, depending on the individual’s risk factors and other medical conditions. There are different types of surgeries used to treat closed-angle glaucoma, and there are potential risks associated with these procedures.

1. Eye drops

Eye drops are an important and common form of treatment for closed-angle glaucoma. These drugs reduce the production of aqueous humor and improve and help to maintain normal eye pressure. This can be done by using anti-glaucoma eye drops, which help reduce the production of aqueous humor and improve drainage through the drainage canals.

There are several types of eye drops available, including prostaglandin analogs, beta-blockers, carbonic anhydrase inhibitors, and miotics. These medications can help reduce the risk of vision loss associated with closed-angle glaucoma and should be used as directed by your eye doctor.

Various kinds of eye drops can be used to treat close-angle glaucoma, including prostaglandin analogs, beta-blockers, carbonic anhydrase inhibitors, and miotics

2. Oral medication

Oral medications prescribed by an ophthalmologist may be used as a form of treatment for closed-angle glaucoma. These medications work to reduce the production of ITF or increase its outflow from the eye. This helps to lower eye pressure safely and effectively. Medications commonly prescribed for this purpose include acetazolamide and latanoprost.

In addition, oral medications can also help reduce severe eye pain and improve fluid drainage in those at risk for glaucoma. Be sure to follow your doctor’s instructions when taking these medications, as they can be beneficial in managing this serious eye condition.

3. Laser trabeculoplasty

Laser trabeculoplasty (LTP) is a safe and effective procedure that uses laser energy to redirect fluid through small channels in the eye (trabecular meshwork). This laser surgery increases the outflow of fluid in a very controlled manner, which helps to improve drainage and reduce intraocular pressure.

This procedure can also help to relieve eye pain and discomfort associated with glaucoma. While it is not a cure for glaucoma, it can provide significant relief from symptoms. It also preserves vision in those affected by this condition.

4. Incisional Surgery

Incisional surgery is a type of treatment used to treat closed-angle glaucoma. This procedure involves making an incision in the eye to improve fluid drainage and reduce elevated eye pressure. The goal of this glaucoma surgery is to prevent further damage to the optic nerve, which can lead to vision loss if left untreated. Incisional surgery is typically used when other treatments, such as laser treatment or medications, are not effective in controlling the condition.

It is important for those with closed-angle glaucoma to have regular eye exams and follow their doctor’s instructions for treatment. Incisional surgery can be an effective treatment to reduce elevated eye pressure and prevent further damage from occurring. However, it is important to note that this type of surgery may not be suitable for all forms of glaucoma, so it is important to speak with your eye doctor about the best course of action for your individual situation.

5. Miotic Therapy

Miotic therapy is a type of treatment used to treat closed-angle glaucoma. This type of glaucoma occurs when the angle between the iris and cornea becomes too narrow, resulting in increased fluid pressure within the eye. This increased pressure can result in damage to the optic nerve, leading to reduced vision and severe pain.

Miotic therapy works by constricting the pupil, which helps reduce fluid pressure in the eye, preventing further damage from occurring. People with glaucoma may be prescribed miotic drops or ointments to help reduce their symptoms and prevent further eye injury. Miotics are usually used in combination with other treatments, such as laser trabeculoplasty or incisional surgery, to provide maximum relief from symptoms and preserve vision. It is important for people with glaucoma to follow their doctor’s instructions for treatment and have regular eye exams to monitor their condition.

6. Implant devices

Implant devices are a type of medical treatment used to treat closed-angle glaucoma. This condition is characterized by increased pressure within the eye, which can lead to irreversible vision loss if left untreated. The goal of treatment is to reduce intraocular pressure to prevent further damage from occurring. Implant devices are surgically placed into the eye and work by draining excess fluid away from the area, thus reducing pressure.

Implant devices are successful in treating closed-angle glaucoma when other treatments such as laser trabeculoplasty or miotic therapy have not been effective. It is important for those with this condition to have regular eye exams in order to monitor their progress and ensure that their treatment is working properly. With proper medical care and routine eye exams, those with closed-angle glaucoma can successfully manage their condition and preserve their vision.

Implantable devices such as iStent or Hydrus Microstent might be suggested, depending on the patient’s condition. It works by creating artificial openings, providing a better flow rate.

7. External Drainage Devices (EDDs)

External Drainage Devices (EDDs) are a type of medical treatment used to treat closed-angle glaucoma. EDDs work by draining excess fluid away from the area, thus reducing pressure and preventing further damage from occurring. Evidence of damage to the optic nerve head should be present before considering EDD therapy in combination with other treatments, such as laser trabeculoplasty or miotic therapy.

Those with closed-angle glaucoma need to have regular vision examinations in order to monitor their condition and ensure that their treatment is working properly. Visual acuity tests can help detect any changes in vision that may indicate a need for additional treatment or an increase in risk factors for lost vision. If successful, EDD therapy can help reduce intraocular pressure and preserve vision in those with closed-angle glaucoma.

Complications Related to Closed-Angle Glaucoma

The most common complication of closed-angle glaucoma is vision loss. If left untreated, increased pressure within the eye can cause irreversible damage to the optic nerve, resulting in permanent vision loss. In some cases, this damage can be so severe that, even with treatment, some degree of vision loss may still occur. Additionally, if left untreated for too long, closed-angle glaucoma can lead to complete blindness.

Closed-angle glaucoma can also cause other complications, such as pain and discomfort in the eyes. This is due to the increased pressure within the eye, which can cause a feeling of pressure or aching in or around the eyes. Additionally, people with this condition may experience headaches and nausea due to the increased pressure on their optic nerves.

Finally, closed-angle glaucoma can also lead to an increase in intraocular pressure (IOP). This is because when fluid builds up in the eye due to blocked drainage pathways, it increases IOP, which can further damage the optic nerve and lead to vision loss. Those with this condition need to have regular eye exams in order to monitor their IOP levels.

Tips for Managing and Preventing Closed-Angle Glaucoma

• Have regular eye exams to monitor your condition and ensure that your treatment is working properly
• Take medications as prescribed by your doctor to help reduce intraocular pressure.
• Wear sunglasses when outdoors to protect your eyes from UV rays
• Avoid activities that increase intraocular pressure, such as straining or lifting heavy objects
• Eat a healthy diet rich in fruits and vegetables to help maintain good vision and health
• Exercise regularly to improve circulation and reduce stress levels
• Quit smoking if you are a smoker, as it can increase the risk of developing glaucoma

Ready for a consultation?

If you are looking for treatment options and want state-of-the-art glaucoma treatment, you need a doctor with experience. The eye specialists at EyeSight Hawaii in Honolulu, HI, and Maui, HI, have the knowledge to help. Make an appointment online or call our office to schedule a consultation today!

Angle-closure glaucoma

Angle-closure glaucoma

Primary angle-closure glaucoma occurs in 15 to 40% of glaucoma cases in Kazakhstan, while it occurs significantly more often in people of eastern origin (up to 80% of glaucoma cases in the population). Women suffer from angle-closure glaucoma much more often than men in a ratio of 3:1.

The peculiarity of the structure of the anterior segment of the eye in this type of glaucoma determines some important causes of its occurrence and the nature of the course of the disease. The structure of the angle is due to the relatively large size of the lens, due to which the iris moves forward, closer to the cornea. A narrow, beak-shaped or closed angle of the anterior chamber creates a certain obstacle to the flow of intraocular fluid to the drainage network. And since the main amount of intraocular fluid flows through the angle of the anterior chamber, slowing down the outflow at this level can lead to an increase in intraocular pressure.

The initial stages of the disease are asymptomatic. Primarily manifested most often in the form of an acute attack of glaucoma. It may be preceded by episodes of a subacute attack of glaucoma in the form of the appearance of iridescent circles when looking at a light source, short-term pain in the eye, in the eyebrow and temple. With each subacute attack, the condition of the optic nerve worsens, which is reflected in the narrowing of the peripheral visual field.

IOP is usually normal outside of an attack, but after an acute attack/subacute attacks, adhesions occur in the anterior chamber angle, which reduces moisture access to the drainage network and intraocular pressure may increase.

Risk factors

The following are the main risk factors for narrow-angle/close-angle glaucoma: noah network, turning narrow anterior chamber angle closed)

Anterior chamber angle closure mechanisms

► As mentioned above, the special structure of the eye predisposes to the development of narrow-angle/closure-angle glaucoma. With a narrow/closed angle and a large lens, the space between the anterior surface of the lens and the posterior surface of the iris is very narrow, which prevents normal outflow of intraocular fluid through it into the anterior chamber. The accumulation of intraocular fluid in the posterior chamber under the root of the iris leads to the bulging of the latter forward. This condition is called pupillary block, i.e. fluid circulation between the anterior and posterior chambers through the pupil is impaired. If the condition of the pupillary block progresses, then the root of the iris comes into contact with the cornea, causing blockade of the angle of the anterior chamber, the outflow of fluid is sharply reduced, and an acute attack of glaucoma occurs. This mechanism blocks the outflow tract of the anterior chamber angle in 70-80% of cases of narrow-angle/closure-angle glaucoma.

► Normal dilation of the pupil in some cases causes obstruction of the outflow tract by the fold of the iris root. This is predisposed by a special attachment of the iris root to the ciliary body – close to the drainage network – the so-called flat iris syndrome. If it is present, prolonged exposure to poor lighting conditions, instillation of drops that dilate the pupil, taking certain medications (psychotropic and some others) can lead to pupil dilation and provoke an acute or subacute attack of glaucoma with all the ensuing consequences.

► In a small percentage of cases, angle-closure glaucoma flows primarily chronically in such a way that there is a gradual formation of adhesions between the periphery of the iris and the anterior wall of the anterior chamber angle. As a result, there is a complete obliteration or fusion of the drainage network, with a persistent increase in intraocular pressure.

► In very rare cases, anterior chamber angle closure is caused by an anterior displacement of the vitreous body along with the lens due to accumulation of fluid in the posterior regions of the eye. It usually occurs as a complication of glaucoma surgery in eyes with a narrow/closed anterior chamber angle.

There are other causes that cause the anterior chamber angle to close: due to intraocular tumors, inflammatory processes, etc. But they cause secondary glaucoma, the treatment of which is to remove the immediate cause and reduce intraocular pressure by various methods.

Acute attack of glaucoma

An acute attack usually occurs suddenly, against the background of general well-being. The immediate causes of an acute attack are not exactly known. Its occurrence can be facilitated by emotional overload, stress, prolonged exposure to a dark room, instillation of drops that dilate the pupil, etc.

In the matter of saving eyesight in an acute attack of glaucoma, hours count.

In an acute attack, there is a sharp pain in the eye, blurring and a sharp decrease in vision, redness of the eye, headache, accompanied by nausea and vomiting. The pupil is dilated. Due to the occlusion of the outflow tracts by the protruding iris root and a decrease in the rate of outflow of intraocular fluid, there is a sharp, strong and persistent increase in intraocular pressure, which leads to irreversible damage to the optic nerve fibers. In the matter of saving vision in such a situation, the clock counts. You need to seek specialized help as soon as possible. Hospitalization in the eye department is required.

Treatment is to reduce intraocular pressure with drugs in the form of drops, tablets, injections, hirudotherapy. Laser iridectomy is effective in the treatment of an acute attack that has arisen by the mechanism of pupillary block. In the absence of the effect of drug and laser treatment, a surgical operation is required.

Diagnosis and treatment of angle-closure glaucoma

Routine examination by an ophthalmologist with gonioscopy will suspect narrow-angle/angle-closure glaucoma. Ultrasound biomicroscopy and optical coherence tomography of the anterior segment will allow visualization and assessment of the structures of the anterior chamber angle, the size and ratio of the lens, and other important details. Read more about Glaucoma screening.

Every patient with a narrow/closed anterior chamber angle is at high risk of developing an acute glaucoma attack. Therefore, in view of the lack of accurate signs to predict the likelihood of an acute attack, the prevention of its occurrence is extremely important.

Prevention of irreversible blindness and disability from glaucoma consists, in particular, in the prevention of an acute attack. And early detection of a narrow/closed angle of the anterior chamber consists in preventive examinations by an ophthalmologist of all persons over 40 years of age.

As a rule, drug treatment of angle-closure or narrow-angle glaucoma begins with the appointment of drugs that narrow the pupil, such as pilocarpine, fotil. These drugs are effective in controlling blood pressure and/or preventing an attack in most cases. But long-term use of pilocarpine can cause sluggish inflammation of the ciliary body, contribute to the progression of cataracts and the formation of adhesions between the iris and the lens, which in the future greatly complicates cataract surgery.

Angle-closure glaucoma, which occurs as a pupillary block, is successfully treated with laser iridectomy, which facilitates the access of intracameral moisture to the outflow tracts, equalizes the pressure between the chambers, reduces intraocular pressure and is, to a certain extent, the prevention of an acute attack. If this event is not enough, then glaucoma drops are prescribed, for example, beta-blockers, Azopt, or prostaglandin preparations. Many researchers believe that in most cases, after laser iridotomy, the appointment of drugs that narrow the pupil is inappropriate. In some cases (on average 15%), laser iridectomy does not eliminate the blockade of the anterior chamber angle, this may be due to the flat iris syndrome, a large thickness of the lens in the region of its equator, and other reasons. In case of inadequate decrease in intraocular pressure when using medicinal and laser methods of treatment, the question arises of the surgical treatment of angle-closure glaucoma.

Since one of the primary roles in the development of angle-closure glaucoma is played by a massive lens that blocks the outflow tract, in the presence of even the slightest clouding in the lens, many researchers recommend early cataract phacoemulsification with intraocular lens implantation. This operation allows you to open the angle of the anterior chamber, thereby facilitating the outflow of intraocular fluid. The threat of an acute attack after removal of the lens is removed, and the need for drops that narrow the pupil disappears.

Primary angle-closure glaucoma – causes, symptoms, treatment and prevention

The incidence of primary angle-closure glaucoma in Russia is about 15-40%, but in patients of oriental origin this figure exceeds 80%. In women, the disease is diagnosed three times more often.

In case of angle-closure glaucoma, the peculiarity of the anatomical structure of the anterior segment of the eye is of great importance. The structure of the angle of the anterior chamber of the eye is associated with a large size of the lens, resulting in an anterior displacement of the iris, that is, closer to the cornea. An obstruction to the outflow of aqueous humor occurs at a narrow, closed or beak-shaped angle. In connection with the violation of the penetration of fluid to the drainage system, there is an increase in its intraocular volume, which causes an increase in pressure inside the eye.

The initial stages of the disease go unnoticed by the patient. Most often, a person learns about the presence of glaucoma after the first acute attack of intraocular hypertension. Harbingers of an attack can be symptoms such as the appearance of iridescent circles while looking at point sources of light, short-term pain in the eye, in the temple and eyebrows. With each attack of intraocular hypertension, the condition of the optic nerve deteriorates, which leads to a narrowing of the peripheral border of the visual field.

Between attacks, intraocular pressure remains at normal levels. After an attack, adhesions form in the area of ​​the angle of the anterior chamber, which reduces the filtration of aqueous humor to the drainage network. In this case, the baseline intraocular pressure also rises.

Risk factors

Risk factors for angle-closure glaucoma include:

1. Age over 40 years, as patients of this age group develop dystrophic processes, and the thickened lens presses the iris root against the structures of the drainage network. This turns the narrow angle into a closed angle of the anterior eye chamber.
2. Female.
3. Small anterior chamber.
4. Nationality. Indigenous peoples of Siberia, Altai, Transcaucasia, Central Asia fall ill with angle-closure glaucoma much more often than residents of the European part of Russia.
5. Farsightedness in which the patient wears lenses with a plus value.
6. Absence of regular visits to the ophthalmologist for a professional examination.
7. Signs of impaired peripheral or central circulation.
8. Anterior chamber angle closing mechanisms

Some structural features of the anterior corner of the eye predispose to the development of angle-closure glaucoma. If the angle is narrow or closed and the lens is relatively large, then the space formed by the posterior surface of the iris and the anterior surface of the lens narrows. This slows down the filtration of intraocular fluid from the posterior chamber of the eye to the anterior. The pressure in the posterior chamber of the eye increases, and the root of the iris begins to bulge forward. Such changes lead to the formation of the so-called pupillary block, which impedes the circulation of fluid between the posterior and anterior chambers of the eyeball.

With the progression of the pupillary block, the iris root adjoins the surface of the cornea, which blocks the anterior chamber of the eye. In this case, the outflow of fluid through the angle of the anterior chamber is disturbed and an acute attack of glaucoma occurs. This mechanism of fluid filtration impairment is realized in most cases (70-80%) in patients with angle-closure glaucoma.

Even the usual long-term dilation of the pupillary opening can lead to impaired outflow of fluid from the posterior chamber to the anterior. Some anatomical features contribute to such changes, for example, the flat iris syndrome, when the root of the iris is attached in this way to the ciliary body, which is located in close proximity to the drainage network. Patients with this structure of the eye, after using drugs (psychotropic) and eye drops that dilate the pupil, or prolonged exposure to darkness, experience symptoms of an acute increase in intraocular pressure. That is, they have an acute attack of glaucoma.

Quite rarely angle-closure glaucoma proceeds along the primary chronic path, resulting in the formation of adhesions between the anterior wall of the corner of the eye and the peripheral zone of the iris. As a result, complete fusion or obliteration of the drainage network gradually develops. This leads to a persistent violation of fluid filtration and a constant increase in intraocular pressure.

An extremely rare cause of angle-closure glaucoma is an anterior displacement of the lens and vitreous body, which is associated with the accumulation of fluid in the posterior regions of the eyeball. Most often, this is a complication of surgical treatment of glaucoma with an anatomically narrow angle of the anterior chamber of the eyeball.

Other causes that cause a violation of the outflow of aqueous humor through the anterior angle are: intraocular tumor neoplasms, the result of inflammatory changes. At the same time, glaucoma occurs as a secondary process, in connection with which the efforts of doctors should be aimed at eliminating the root cause, as well as reducing the level of intraocular pressure by all available means.

Acute attack of glaucoma

An acute attack of glaucoma usually develops against a background of general well-being. It is quite difficult to establish the exact cause of the development of an attack. Stress, emotional overload, prolonged stay in a dark room, the use of drops to dilate the pupil can contribute to the development of the disease.

It is important to note that in an acute attack of glaucoma, hours count, otherwise the patient may permanently lose sight.
In an acute attack of glaucoma, the patient has a sudden severe pain in the eye, blurred vision, its sharpness is significantly reduced. Also, redness of the eye, pain in the head, neurological manifestations in the form of vomiting and nausea join. Due to the bulging of the iris, the outflow of intraocular fluid is closed, so there is a persistent, sharp and pronounced increase in intraocular pressure. Hypertension, in turn, causes irreversible damage to the optic nerve fibers, so it is necessary to reduce the pressure as soon as possible. If you do not seek specialized help in time, then complete loss of vision is guaranteed. Treatment is carried out in an ophthalmological hospital.

Drops, injections, tablets and even hirudotherapy are used to eliminate intraocular hypertension. If an acute attack of glaucoma is associated with the development of a pupillary block, then laser iridectomy will be effective. With insufficient effectiveness of laser treatment or drug therapy, surgical intervention is performed.

Diagnosis and treatment of angle-closure glaucoma

Even in the absence of symptoms, angle-closure glaucoma can be suspected by ophthalmoscopy with gonioscopy. In order to more clearly assess the structure of the anterior chamber of the eye and its angle, optical coherence tomography and ultrasound biomicroscopy of the eyeball will be required. These techniques will also help to assess the size of the lens, its relationship with the surrounding structures.

If a patient has ever been diagnosed with a narrow angle of the anterior chamber of the eye, then the risk of developing an acute attack of glaucoma increases. In this regard, it is necessary to explain to such patients the importance of regular visits to the ophthalmologist and the implementation of preventive measures.
Acute glaucoma prophylaxis should be performed to reduce the chance of total irreversible blindness and associated disability.

For early detection of a tendency to glaucoma, that is, an anatomically narrow angle of the anterior chamber of the eye, regular preventive examinations by an ophthalmologist are necessary, especially for patients over 40 years of age.

Drug therapy for narrow-angle or angle-closure glaucoma begins with drugs that constrict the pupil. These include fotil, pilocarpine. Most often, they help control the level of intraocular pressure and prevent the development of an acute attack of intraocular hypertension. At the same time, long-term use of pilocarpine is not recommended, since this causes sluggish inflammation of the ciliary body, adhesions are formed between the iris and the lens, cataract symptoms progress. In the future, these changes can significantly complicate the operation to remove the lens, changed by cataract.

In case of pupillary block, angle-closure glaucoma can be treated with laser iridectomy. As a result of the operation, the filtration of aqueous humor from the posterior chamber of the eye to the anterior chamber improves, which leads to a decrease in intraocular pressure and can be considered as a prevention of the development of an acute attack of glaucoma. If this operation was not enough, then eye drops with a beta-blocker, prostaglandins or Azopt are additionally used. Most doctors believe that after laser iridotomy, further prescription of miotics is inappropriate. In about 15% of patients, laser iridectomy does not resolve the pupillary block. One of the reasons for this may be the flat iris syndrome and the large thickness of the lens in the equatorial zone. If against the background of laser treatment and drug therapy it was not possible to achieve an adequate decrease in intraocular pressure, then the question of surgical treatment of glaucoma should be considered.