closed angle glaucoma

Question 1

definition of glaucoma

Answer 1

Angle-closure glaucoma (ACG) is a group of diseases in which there is reversible (appositional) or adhesional (synechial) closure of the anterior-chamber angle resulting in elevation of the intra-ocular pressure (IOP).

Question 2

how does acute angle-closure glaucoma develop

Answer 2

the pupillary block mechanism (which pushes the iris from behind) blocks the trabecular meshwork of the iris suddenly

Question 3

how does chronic angle-closure glaucoma develop

Answer 3

after acute where closure of angle persists
OR
over time as angle closes from repeated contact between peripheral iris and trabecular meshwork
often leads to peripheral anterior synechiae (PAS) and functional damage to the angle.

Question 4

signs and symptoms of glaucoma

Answer 4

high IOP (>21mmHg, can be 40mmHg in acute)

all with acute not chronic:

• halos around lights
• aching eye or brow pain
• headache
• nausea/vom
• reduced acuity
• red eye
• cornea oedema - acute
• fixed dilated pupil in acute due to ischemia

Question 5

RF for glaucoma

Answer 5

• female
• hyperopia (far sighted)
• shallow peripheral anterior chamber
• bilateral
• inuit/asian
• age

Question 6

ix for glaucoma

Answer 6

genioscopy - examination of anterior chamber angle -trabecular meshwork is not visible in angle closure, because the peripheral iris is in contact with it
slit lamp
* shallow anterior chamber;
* corneal oedema,
* lens changes,
* corneal endothelial loss

automatic static perimetry - visual field defects

Question 7

mx of acute glaucoma

Answer 7

carbonic anhydrase inhibitors and/or topical B blocker and/or topical alpha 2 agonist
consider
* topical opthalmic cholinergic meds
* hyperosmotic agents

laser peripherali iridotomy after acute attack

Question 8

mx of chronic glaucoma

Answer 8

laser peripheral iridotomy

Question 9

ongoing mx of glaucoma if
residual angle closure after laser peripheral iridotomy with elevated intra-ocular pressure

Answer 9

topical prostaglandin analogues and/or topical beta-blocker and/or topical alpha-2 agonist

Question 10

patient discussions with glaucoma

Answer 10

regular follow up
safety net - return to AE if repeat episode

Question 11

complications of glaucoma

Answer 11

retinal vein occlusion
loss of vision
fellow eye attack
reduced acuity
complications of laser iridotomy
* anterior chamber bleeding
* cataract progression
* dysphotopsia
* spike in IOP

Question 12

predictors of poor IOP control after surgery

Answer 12

Greater extent of PAS,
a higher presenting IOP,
and a larger cup-to-disc ratio

Question 13

definition of sub-acute glaucoma

Answer 13

abrupt onset of symptomatic elevation of IOP, resulting from total closure of the angle, which is self-limiting and recurrent