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Highlights & Basics
- Acute angle-closure glaucoma is an urgent but uncommon, dramatic symptomatic event with blurring of vision, painful red eye, headache, nausea, and vomiting.
- Diagnosis is made by noting high intraocular pressure, corneal edema, shallow anterior chamber, and a closed angle on gonioscopy.
- Medical or surgical therapy is directed at widening the angle and preventing further angle closure.
- If glaucoma has developed it is treated with therapies to lower intraocular pressure.
- Chronic angle-closure glaucoma is diagnosed by noting peripheral anterior synechiae on gonioscopy, as well as progressive damage to the optic nerve and characteristic visual field loss. It is treated with therapies to lower intraocular pressure.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Citations
American Academy of Ophthalmology. Preferred practice pattern: primary angle closure. Nov 2020 [internet publication].[Full Text]
American Academy of Ophthalmology. Glaucoma summary benchmarks - 2024. Dec 2024 [internet publication].[Full Text]
International Council of Ophthalmology. ICO guidelines for glaucoma eye care. Feb 2016 [internet publication].[Full Text]
1. American Academy of Ophthalmology. Preferred practice pattern: primary angle closure. Nov 2020 [internet publication].[Full Text]
2. Tham YC, Li X, Wong TY, et al. Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis. Ophthalmology. 2014 Nov;121(11):2081-90.[Abstract][Full Text]
3. Shan S, Wu J, Cao J, et al. Global incidence and risk factors for glaucoma: a systematic review and meta-analysis of prospective studies. J Glob Health. 2024 Nov 8;14:04252.[Abstract][Full Text]
4. Zhang N, Wang J, Chen B, et al. Prevalence of primary angle closure glaucoma in the last 20 years: a meta-analysis and systematic review. Front Med (Lausanne). 2020;7:624179.[Abstract][Full Text]
5. George R, Panda S, Vijaya L. Blindness in glaucoma: primary open-angle glaucoma versus primary angle-closure glaucoma-a meta-analysis. Eye (Lond). 2022 Nov;36(11):2099-105.[Abstract][Full Text]
6. Shah SN, Zhou S, Sanvicente C, et al. Prevalence and risk factors of blindness among primary angle closure glaucoma patients in the United States: an IRIS registry analysis. Am J Ophthalmol. 2024 Mar;259:131-40.[Abstract][Full Text]
7. Day AC, Baio G, Gazzard G, et al. The prevalence of primary angle closure glaucoma in European derived populations: a systematic review. Br J Ophthalmol. 2012 Sep;96(9):1162-7.[Abstract]
8. Vajaranant TS, Nayak S, Wilensky JT, et al. Gender and glaucoma: what we know and what we need to know. Curr Opin Ophthalmol. 2010 Mar;21(2):91-9.[Abstract][Full Text]
9. Cheng JW, Cheng SW, Ma XY, et al. The prevalence of primary glaucoma in mainland China: a systematic review and meta-analysis. J Glaucoma. 2013 Apr-May;22(4):301-6.[Abstract]
10. Weinreb RN, Aung T, Medeiros FA. The pathophysiology and treatment of glaucoma: a review. JAMA. 2014 May 14;311(18):1901-11.[Abstract][Full Text]
11. American Academy of Ophthalmology. Primary vs. secondary angle closure glaucoma. Oct 2025 [internet publication].[Full Text]
12. Nongpiur ME, Ku JY, Aung T. Angle closure glaucoma: a mechanistic review. Curr Opin Ophthalmol. 2011 Mar;22(2):96-101.[Abstract]
13. Jayaram H, Kolko M, Friedman DS, et al. Glaucoma: now and beyond. Lancet. 2023 Nov 11;402(10414):1788-801.[Abstract]
14. Ahram DF, Alward WL, Kuehn MH. The genetic mechanisms of primary angle closure glaucoma. Eye (Lond). 2015 Oct;29(10):1251-9.[Abstract][Full Text]
15. American Academy of Ophthalmology. Lens induced glaucomas. May 2023 [internet publication].[Full Text]
16. Lachkar Y, Bouassida W. Drug-induced acute angle closure glaucoma. Curr Opin Ophthalmol. 2007 Mar;18(2):129-33.[Abstract][Full Text]
17. American Academy of Ophthalmology. Medication-induced acute angle-closure glaucoma. Oct 2020 [internet publication].[Full Text]
18. Thomas R, George R, Parikh R, et al. Five year risk of progression of primary angle closure suspects to primary angle closure: a population based study. Br J Ophthalmol. 2003 Apr;87(4):450-4.[Abstract][Full Text]
19. Xu L, Cao WF, Wang YX, et al. Anterior chamber depth and chamber angle and their associations with ocular and general parameters: the Beijing eye study. Am J Ophthalmol. 2008 May;145(5):929-36.[Abstract]
20. Alsbirk PH. Angle-closure glaucoma surveys in Greenland Eskimos. A preliminary report. Can J Ophthalmol. 1973 Apr;8(2):260-4.[Abstract]
21. Van Herick W, Shaffer RN, Schwartz A. Estimation of width of angle of anterior chamber. Incidence and significance of the narrow angle. Am J Ophthalmol. 1969 Oct;68(4):626-9.[Abstract]
22. Lowe RF. Aetiology of the anatomical basis for primary angle-closure glaucoma. Biometrical comparisons between normal eyes and eyes with primary angle-closure glaucoma. Br J Ophthalmol. 1970 Mar;54(3):161-9.[Abstract][Full Text]
23. Foster JF, Devereux JG, Alsbirk PH, et al. Detection of gonioscopically occludable angles and primary angle closure glaucoma by estimation of limbal chamber depth in Asians: modified grading scheme. Br J Ophthalmol. 2000 Feb;84(2);186-92.[Abstract][Full Text]
24. Devereux JG, Foster PJ, Baasanhu J, et al. Anterior chamber depth measurement as a screening tool for primary angle-closure glaucoma in an East Asian population. Arch Ophthalmol. 2000 Feb;118(2):257-63.[Abstract]
25. Flores-Sánchez BC, Tatham AJ. Acute angle closure glaucoma. Br J Hosp Med (Lond). 2019 Dec 2;80(12):C174-9.[Abstract][Full Text]
26. Wang Y, Dong XX, Hou XW, et al. Risk factors for primary angle-closure glaucoma: a systematic review and meta-analysis of 45 studies. Optom Vis Sci. 2023 Sep 1;100(9):606-13.[Abstract]
27. Wright C, Tawfik MA, Waisbourd M, et al. Primary angle-closure glaucoma: an update. Acta Ophthalmol. 2016 May;94(3):217-25.[Abstract][Full Text]
28. Sit AJ, Chen TC, Takusagawa HL, et al. Corneal hysteresis for the diagnosis of glaucoma and assessment of progression risk: a report by the American Academy of Ophthalmology. Ophthalmology. 2023 Apr;130(4):433-42.[Abstract][Full Text]
29. Gazzard G, Foster PJ, Devereux JG, et al. Intraocular pressure and visual field loss in primary angle closure and primary open angle glaucomas. Br J Ophthalmol. 2003 Jun;87(6):720-5.[Abstract]
30. Michelessi M, Lucenteforte E, Oddone F, et al. Optic nerve head and fibre layer imaging for diagnosing glaucoma. Cochrane Database Syst Rev. 2015 Nov 30;(11):CD008803.[Abstract][Full Text]
31. Zimprich L, Diedrich J, Bleeker A, et al. Corneal hysteresis as a biomarker of glaucoma: current insights. Clin Ophthalmol. 2020;14:2255-64.[Abstract][Full Text]
32. Aung T, Friedman DS, Chew PT, et al. Long-term outcomes in Asians after acute primary angle closure. Ophthalmology. 2004 Aug;111(8):1464-9.[Abstract]
33. Foster PJ, Buhrmann R, Quigley HA, et al. The definition and classification of glaucoma in prevalence surveys. Br J Ophthalmol. 2002 Feb;86(2):238-42.[Abstract][Full Text]
34. Xu BY, Richter GM, Burkemper BS, et al. Prevalence and risk factors of primary angle closure disease in an adult Chinese American population: the Chinese American eye study. Am J Ophthalmol. 2025 Jun;274:32-41.[Abstract]
35. Kavitha S, Zebardast N, Palaniswamy K, et al. Family history is a strong risk factor for prevalent angle closure in a South Indian population. Ophthalmology. 2014 Nov;121(11):2091-7.[Abstract]
36. The Royal College of Ophthalmologists. Management of angle closure glaucoma guideline. Jun 2022 [internet publication].[Full Text]
37. American Academy of Ophthalmology. Preferred practice pattern: comprehensive adult medical eye evaluation PPP 2020. Nov 2020 [internet publication].[Full Text]
38. American Academy of Ophthalmology. Glaucoma summary benchmarks - 2024. Dec 2024 [internet publication].[Full Text]
39. International Council of Ophthalmology. ICO guidelines for glaucoma eye care. Feb 2016 [internet publication].[Full Text]
40. European Glaucoma Society. Terminology and guidelines for glaucoma: 5th edition. 2021 [internet publication].[Full Text]
41. American Academy of Ophthalmology. Referral of persons with possible eye diseases or injury - 2014. Apr 2014 [internet publication].[Full Text]
42. Yang X, Su W, Wang M, et al. Effect of anterior chamber paracentesis on initial treatment of acute angle closure. Can J Ophthalmol. 2013 Dec;48(6):553-8.[Abstract]
43. Arnavielle S, Creuzot-Garcher C, Bron AM. Anterior chamber paracentesis in patients with acute elevation of intraocular pressure. Graefes Arch Clin Exp Ophthalmol. 2007 Mar;245(3):345-50.[Abstract]
44. Rouse B, Le JT, Gazzard G. Iridotomy to slow progression of visual field loss in angle-closure glaucoma. Cochrane Database Syst Rev. 2023 Jan 9;1(1):CD012270.[Abstract][Full Text]
45. Radhakrishnan S, Chen PP, Junk AK, et al. Laser peripheral iridotomy in primary angle closure: a report by the American Academy of Ophthalmology. Ophthalmology. 2018 Jul;125(7):1110-20.[Abstract][Full Text]
46. Ritch R. Argon laser peripheral iridoplasty: an overview. J Glaucoma. 1992;1:206-13.
47. Ong AY, McCann P, Perera SA, et al. Lens extraction versus laser peripheral iridotomy for acute primary angle closure. Cochrane Database Syst Rev. 2023 Mar 8;3(3):CD015116.[Abstract][Full Text]
48. Azuara-Blanco A, Burr J, Ramsay C, et al. Effectiveness of early lens extraction for the treatment of primary angle-closure glaucoma (EAGLE): a randomised controlled trial. Lancet. 2016 Oct 1;388(10052):1389-97.[Abstract][Full Text]
49. Chen MJ, Chen YC, Chou CK, et al. Comparison of the effects of latanoprost and travoprost on intraocular pressure in chronic angle-closure glaucoma. J Ocul Pharmacol Ther. 2006 Dec;22(6):449-54.[Abstract]
50. Aung T, Chan YH, Chew PT. EXACT Study Group. Degree of angle closure and the intraocular pressure-lowering effect of latanoprost in subjects with chronic angle-closure glaucoma. Ophthalmology. 2005 Feb;112(2):267-71.[Abstract]
51. Aung T, Tow SL, Yap EY, et al. Trabeculectomy for acute primary angle closure. Ophthalmology. 2000 Jul;107(7):1298-302.[Abstract][Full Text]
52. Tseng VL, Coleman AL, Chang MY, et al. Aqueous shunts for glaucoma. Cochrane Database Syst Rev. 2017 Jul 28;(7):CD004918.[Abstract][Full Text]
53. Honrubia F, García-Sánchez J, Polo V, et al. Conjunctival hyperaemia with the use of latanoprost versus other prostaglandin analogues in patients with ocular hypertension or glaucoma: a meta-analysis of randomised clinical trials. Br J Ophthalmol. 2009 Mar;93(3):316-21.[Abstract][Full Text]
54. Park J, Rittiphairoj T, Wang X, et al. Device-modified trabeculectomy for glaucoma. Cochrane Database Syst Rev. 2023 Mar 13;3(3):CD010472.[Abstract][Full Text]
55. El-Saied HM, Abdelhakim MA. Trabeculectomy with ologen in secondary glaucomas following failed trabeculectomy with MMC: comparative study. Eye (Lond). 2016 Aug;30(8):1126-34.[Abstract][Full Text]
56. Jackson ML, Virgili G, Shepherd JD, et al. Vision rehabilitation preferred practice pattern®. Ophthalmology. 2023 Mar;130(3):P271-335.[Full Text]
57. Wishart PK, Atkinson PL. Extracapsular cataract extraction and posterior chamber lens implantation in patients with primary chronic angle-closure glaucoma: effect on intraocular pressure control. Eye. 1989;3(Pt 6):706-12.[Abstract]
58. Gunning FP, Greve EL. Lens extraction for uncontrolled glaucoma. J Cataract Refract Surg. 1998 Oct;24(10):1347-56.[Abstract]
59. Ang LP, Aung T, Chua WH, et al. Visual field loss from primary angle-closure glaucoma: a comparative study of symptomatic and asymptomatic disease. Ophthalmology. 2004 Sep;111(9):1636-40.[Abstract]
60. Salmon JF. Long-term intraocular pressure control after Nd:YAG laser iridotomy in chronic angle-closure glaucoma. J Glaucoma. 1993 Winter;2(4):291-6.[Abstract]
61. Rosman M, Aung T, Ang LP, et al. Chronic angle-closure with glaucomatous damage: longterm clinical course in a North American population and comparison with an Asian population. Ophthalmology. 2002 Dec;109(12):2227-31.[Abstract]
62. Chong YF, Irfan S, Menege MS. AACG: an evaluation of a protocol for acute treatment. Eye. 1999 Oct;13(5):613-6.[Abstract]
63. Bain WE. The fellow eye in acute closed-angle glaucoma. Br J Ophthalmol. 1957 Apr;41(4):193-9.[Abstract][Full Text]
64. Hyams SW, Friedman Z, Keroub C. Fellow eye in angle-closure glaucoma. Br J Ophthalmol. 1975 Apr;59(4):207-10.[Abstract]
65. Lowe RF. Acute angle-closure glaucoma. The second eye: an analysis of 200 cases. Br J Ophthalmol. 1962 Nov;46(11):641-50.[Abstract][Full Text]
66. Kavitha S, Ramulu PY, Venkatesh R, et al. Resolution of visual dysphotopsias after laser iridotomy: six-month follow-up. Ophthalmology. 2019 Mar;126(3):469-71.e1.[Abstract][Full Text]
67. Hollows FC, Graham PA. Intra-ocular pressure, glaucoma, and glaucoma suspects in a defined population. Br J Ophthalmol. 1966 Oct;50(10):570-86.[Abstract][Full Text]
68. Ang LP, Aung T, Chew PT. Acute primary angle closure in an Asian population: long-term outcome of the fellow eye after prophylactic laser peripheral iridotomy. Ophthalmology. 2000 Nov;107(11):2092-6.[Abstract]
