Angle-closure glaucoma - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

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.

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History & Exam
- Key Factors
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Diagnostics Tests
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Treatment Options
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Definition

Epidemiology

Etiology

Pathophysiology

Citations

Key Articles

American Academy of Ophthalmology. Preferred practice pattern: primary angle closure. November 2020 [internet publication].[Full Text]
International Council of Ophthalmology. ICO guidelines for glaucoma eye care. February 2016 [internet publication].[Full Text]
American Academy of Ophthalmology. Glaucoma summary benchmarks - 2023. Dec 2023 [internet publication].[Full Text]

Referenced Articles

1. Association of International Glaucoma Societies (AGIS) 3rd consensus meeting. Florida, USA. May 2006.
2. Quigley HA, Broman AT. The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol. 2006 Mar;90(3):262-7.[Abstract]
3. Quigley HA. Number of people with glaucoma worldwide. Br J Ophthalmol. 1996 May;80(5):389-93.[Abstract][Full Text]
4. Bankes JL, Perkins ES, Tsolakis S, et al. Bedford glaucoma survey. Br Med J. 1968 Mar 30;1(5595):791-6.[Abstract][Full Text]
5. 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]
6. Bengtsson B. The prevalence of glaucoma. Br J Ophthalmol. 1981 Jan;65(1):46-9.[Abstract][Full Text]
7. Congdon N, Wang F, Tielsch JM. Issues in the epidemiology and population-based screening of primary angle-closure glaucoma. Surv Ophthalmol. 1992 May-Jun;36(6):411-23.[Abstract]
8. Foster PJ, Johnson GJ. Glaucoma in China: how big is the problem? Br J Ophthalmol. 2001 Nov;85(11):1277-82.[Abstract][Full Text]
9. He M, Foster PJ, Johnson GJ, et al. Angle-closure glaucoma in East Asian and European people. Different diseases? Eye. 2006 Jan;20(1):3-12.[Abstract]
10. Drance SM. Angle closure glaucoma among Canadian Eskimos. Can J Ophthalmol. 1973 Apr;8(2):252-4.[Abstract]
11. Alsbirk PH. Angle-closure glaucoma surveys in Greenland Eskimos. A preliminary report. Can J Ophthalmol. 1973 Apr;8(2):260-4.[Abstract]
12. Johnson GJ, Green JS, Paterson GD, et al. Survey of ophthalmic conditions in a Labrador community: II. Ocular disease. Can J Ophthalmol. 1984 Aug;19(5):224-33.[Abstract]
13. Johnson GJ, Foster PJ. Can we prevent angle-closure glaucoma? Eye. 2005 Oct;19(10):1119-24.[Abstract]
14. Klein BE, Klein R, Sponsel WE, et al. Prevalence of glaucoma. The Beaver Dam Eye Study. Ophthalmology. 1992 Oct;99(10):1499-504.[Abstract][Full Text]
15. Wensor MD, McCarty CA, Stanislavsky YL, et al. The prevalence of glaucoma in the Melbourne Visual Impairment Project. Ophthalmology. 1998 Apr;105(4):733-9.[Abstract]
16. 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]
17. American Academy of Ophthalmology. Preferred practice pattern: primary angle closure. November 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. 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]
20. 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]
21. 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]
22. 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]
23. 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]
24. Chong YF, Irfan S, Menege MS. AACG: an evaluation of a protocol for acute treatment. Eye. 1999 Oct;13(5):613-6.[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. 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]
27. Lachkar Y, Bouassida W. Drug-induced acute angle closure glaucoma. Curr Opin Ophthalmol. 2007 Mar;18(2):129-33.[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. International Council of Ophthalmology. ICO guidelines for glaucoma eye care. February 2016 [internet publication].[Full Text]
30. Lai JS, Gangwani RA. Medication-induced acute angle closure attack. Hong Kong Med J. 2012 Apr;18(2):139-45.[Abstract][Full Text]
31. 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]
32. 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]
33. 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]
34. 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]
35. American Academy of Ophthalmology. Glaucoma summary benchmarks - 2023. Dec 2023 [internet publication].[Full Text]
36. American Academy of Ophthalmology. Preferred practice pattern: comprehensive adult medical eye evaluation PPP 2020. Nov 2020 [internet publication].[Full Text]
37. European Glaucoma Society. Terminology and guidelines for glaucoma: 5th edition. 2021 [internet publication].[Full Text]
38. American Academy of Ophthalmology. Referral of persons with possible eye diseases or injury - 2014. Apr 2014 [internet publication].[Full Text]
39. Hung L, Yang CH, Chen MS. Effect of pilocarpine on anterior chamber angles. J Ocul Pharmacol Ther. 1995 Fall;11(3):221-6.[Abstract]
40. Luo KS. Application of paracentesis of anterior chamber in treatment of consistent high introcular pressure of acute angle-closure glaucoma. Int J Ophthalmol. 2011;9:1611-13.
41. Ritch R. The treatment of chronic angle-closure glaucoma. Ann Ophthalmol. 1981 Jan;13(1):21-3.[Abstract]
42. Quigley HA. Long-term follow-up of laser iridotomy. Ophthalmology. 1981 Mar;88(3):218-24.[Abstract]
43. Robin AL, Pollack IP. Argon laser peripheral iridotomies in the treatment of primary angle-closure glaucoma: long-term follow-up. Arch Ophthalmol. 1982 Jun;100(6):919-23.[Abstract]
44. Jiang Y, Chang DS, Foster PJ, et al. Immediate changes in intraocular pressure after laser peripheral iridotomy in primary angle-closure suspects. Ophthalmology. 2012 Feb;119(2):283-8.[Abstract]
45. American Academy of Ophthalmology. Laser peripheral iridotomy for pupillary-block glaucoma. Ophthalmology. 1994 Oct;101(10):1749-58.[Abstract]
46. Bayliss JM, Ng WS, Waugh N, et al. Laser peripheral iridoplasty for chronic angle closure. Cochrane Database Syst Rev. 2021 Mar 23;3:CD006746.[Abstract][Full Text]
47. Ritch R, Tham CC, Lam DS. Argon laser peripheral iridoplasty (ALPI): an update. Surv Ophthalmol. 2007 May-Jun;52(3):27988.[Abstract]
48. Aung T, Ang LP, Chen SP, et al. Acute primary angle-closure: long term intraocular pressure outcome in Asian eyes. Am J Ophthalmol. 2001 Jan;131(1):7-12.[Abstract]
49. Bain WE. The fellow eye in acute closed-angle glaucoma. Br J Ophthalmol. 1957 Apr;41(4):193-9.[Abstract][Full Text]
50. Hyams SW, Friedman Z, Keroub C. Fellow eye in angle-closure glaucoma. Br J Ophthalmol. 1975 Apr;59(4):207-10.[Abstract]
51. 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]
52. 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]
53. Ritch R. Argon laser peripheral iridoplasty: an overview. J Glaucoma. 1992;1:206-13.
54. Harasymowycz PJ, Papamatheakis DG, Ahmed I, et al. Phacoemulsification and goniosynechialysis in the management of unresponsive primary angle closure. J Glaucoma. 2005 Jun;14(3):186-9.[Abstract]
55. Teekhasaenee C, Ritch R. Combined phacoemulsification and goniosynechialysis for uncontrolled chronic ACG after acute angle-closure glaucoma. Ophthalmology. 1999 Apr;106(4):669-74.[Abstract]
56. 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]
57. Greve EL. Primary ACG: extracapsular cataract extraction or filtrating procedure? Int Ophthalmol. 1988;12:157-62.[Abstract]
58. Gunning FP, Greve EL. Lens extraction for uncontrolled glaucoma. J Cataract Refract Surg. 1998 Oct;24(10):1347-56.[Abstract]
59. American Academy of Ophthalmology. Preferred practice pattern: Primary open-angle Glaucoma PPP 2020. Nov 2020 [internet publication].[Full Text]
60. 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]
61. 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]
62. Aung T, Tow SL, Yap EY, et al. Trabeculectomy for acute primary angle closure. Ophthalmology. 2000 Jul;107(7):1298-302.[Abstract][Full Text]
63. Tseng VL, Coleman AL, Chang MY, et al. Aqueous shunts for glaucoma. Cochrane Database Syst Rev. 2017 Jul 28;(7):CD004918.[Abstract][Full Text]
64. 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]
65. Masselos K, Bank A, Francis IC, et al. Corneal indentation in the early management of acute angle closure. Ophthalmology. 2009 Jan;116(1):25-9.[Abstract]
66. Lam DS, Tham CC, Lai JS, et al. Current approaches to the management of acute primary angle closure. Curr Opin Ophthalmol. 2007 Mar;18(2):146-51.[Abstract]
67. Francis BA, Singh K, Lin SC, et al. Novel glaucoma procedures: a report by the American Academy of Ophthalmology. Ophthalmology. 2011 Jul;118(7):1466-80.[Abstract]
68. Chai C, Loon SC. Meta-analysis of viscocanalostomy versus trabeculectomy in uncontrolled glaucoma. J Glaucoma. 2010 Oct-Nov;19(8):519-27.[Abstract]
69. Wang X, Khan R, Coleman A. Device-modified trabeculectomy for glaucoma. Cochrane Database Syst Rev. 2015 Dec 1;(12):CD010472.[Abstract][Full Text]
70. Jackson ML, Virgili G, Shepherd JD, et al. Vision rehabilitation preferred practice pattern®. Ophthalmology. 2023 Mar;130(3):P271-335.[Full Text]
71. 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]
72. 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]
73. 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]
74. 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]