Acute Angle Closure Glaucoma

Question 1

What is the aetiology of acute angle closure glaucoma?

Answer 1

It develops as an after effect of either primary/secondary angle closure glaucoma.

Synechial/oppositional closure of the AC angle by peripheral iris.

Question 2

What are the risk factors of acute angle closure glaucoma?

Answer 2

Age, Female Gender, East Asian, Family Hx, Hyperopia

Question 3

What is the pathogenesis of acute angle closure glaucoma?

Answer 3

• WITH pupil block
• Pupillary dilation leads the iris and lens contact increasing the pupillary block.
• Increasing pupillary block leads to bulging of iris, acutely closing the AC angle, thus obstructing aqueous humour outflow.
• IOP raises slightly.
• WITHOUT pupil block
• Ciliary body positioned anteriorly than normal.
• Iris naturally closer to cornea
• Thickened and convexed peripheral iris fold.

Question 4

What are the different signs of Acute Angle Closure Glaucoma?

Answer 4

• High IOP (40-80mmHg)
• Red Eye
• Reduced Va (6/60-HM)
• Vertical oval pupil
• Shallow/Flat AC
• Closed Angle on VH
• Iridotrabecular contact at 360 degrees on gonioscopy

Question 5

What are the different symptoms presented when a px has Acute Angle Closure Glaucoma?

Answer 5

• Severe Ocular Pain
• Rapid decrease in vision (unilateral)
• Halo’s around light, blurred vision
• Nausea/Vomiting
• Intermittent angle closure glaucoma: same symptoms but milder
• Chronic PAC: usually asymptomatic

Question 6

What investigations would you carry out for acute angle closure glaucoma?

Answer 6

• Gonioscopy (looking for 360 degrees of contact)

- Van Hericks

Question 7

What treatment would be given for acute angle closure glaucoma?

Answer 7

• T - imolol
• A - nti inflammatory agents
• P - ilocarpine
• A - azetazulamide
• S - upine position (lying down)
• P - eripheral
• I - iriditomy

Question 8

What are the differential diagnosis for acute angle closure glaucoma?

Answer 8

• Acute anterior uveitis
• Miotic pupil
• Cells/flares in AC