II. Epidemiology
- Relatively rare compared with Open Angle Glaucoma
III. Risk factors
- Increasing age
- Hyperopia (Far-sightedness)
- Family History of Glaucoma
- Angle closure Glaucoma in contralateral eye
- Pupillary dilation
- Anatomic variant with shallow anterior chamber
- Female gender (2.4 Relative Risk)
IV. Causes: Precipitating Factors
- Dim lighting (results in Mydriasis of the pupil)
- Eye Dilating Drops (Mydriatics)
- Ophthalmic Anticholinergic Agents
- Systemic medications (cause ciliary body edema)
- Antidepressants
- Sulfa-based medications
- Topiramate
V. Pathophysiology
- Drainage obstruction of aqueous from anterior chamber
- Physical blockage of outflow tract by iris
- Narrowing of anterior chamber angle
- Increased aqueous production
VI. Symptoms
- Acute (Usual presentation)
- Decreased Visual Acuity, blurred vision
- Severe Vision Loss in hours to days
- Visual halos or rainbows may occur around streetlights from Corneal edema
- Photophobia
- Headache
- Extreme Eye Pain
- Nausea and Vomiting
- Abdominal discomfort
- Decreased Visual Acuity, blurred vision
- Sub-acute
VII. Signs
- Shallow Anterior Chamber Depth
- Decreased Visual Acuity
- Pupil mildly dilated and sluggishly reactive
- Globe feels firm or rock-hard on palpation through lid
- Increased Intraocular Pressure = 25 - 50 mmHg
- Eye Redness
- Conjunctival edema (Chemosis)
-
Corneal edema
- Cornea cloudy, "steamy", hazy
- Ciliary Flush
- Fundoscopy
- See Open Angle Glaucoma
- See Fundoscopy
- Optic disc cupping
VIII. Differential Diagnosis
- Open Angle Glaucoma
- Narrow Angle Glaucoma often misdiagnosed as:
IX. Management
- Immediate ophthalmology referral
- Treat both eyes (typically progresses to involve both eyes)
- Temporizing measures
- Give Acetazolamide 500 mg orally or IV AND
- Administer all 3 ophthalmic medications (repeated every 5 minutes for 3 doses)
- Timolol maleate 0.5% (Timoptic) AND
- Apraclonidine 1% (Iopidine) given 1 minute after Timolol AND
- Pilocarpine 2% (Isoptocarpine) given 1 minute after Apraclonidine
- Pilocarpine is only effective after lowering eye pressure with Timolol (due to ischemic paralysis of the iris)
- Monitor Intraocular Pressure hourly until patient is seen by ophthalmology
- Surgery (definitive treatment)
- Laser iridotomy
- Iridectomy
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Definition (MSH) | A form of glaucoma in which the intraocular pressure increases because the angle of the anterior chamber is blocked and the aqueous humor cannot drain from the anterior chamber. |
Concepts | Disease or Syndrome (T047) |
MSH | D015812 |
SnomedCT | 392291006, 270882001, 193544008, 33647009 |
English | Angle Closure Glaucomas, Angle-Closure Glaucoma, Angle-Closure Glaucomas, Closed-Angle Glaucoma, Closed-Angle Glaucomas, Glaucoma, Angle Closure, Glaucoma, Angle-Closure, Glaucoma, Closed Angle, Glaucoma, Closed-Angle, Glaucoma, Narrow-Angle, Glaucoma, Uncompensated, Glaucoma, Uncompensative, Glaucomas, Angle Closure, Glaucomas, Angle-Closure, Glaucomas, Closed-Angle, Glaucomas, Narrow-Angle, Glaucomas, Uncompensated, Glaucomas, Uncompensative, Narrow-Angle Glaucoma, Narrow-Angle Glaucomas, Uncompensated Glaucoma, Uncompensated Glaucomas, Uncompensative Glaucoma, Uncompensative Glaucomas, Glaucoma, Narrow Angle, ACG - Angle closure glaucoma, Narrow angle glaucoma, Narrow-angle glaucoma, angle-closure glaucoma (diagnosis), angle-closure glaucoma, Angle glaucoma closed, Glaucoma closed angle, Angle closure glaucoma, Glaucoma, Angle-Closure [Disease/Finding], angle closure glaucoma, glaucoma angle-closure, narrow glaucoma angle, narrow angle glaucoma, closed angle glaucoma, glaucoma narrow angle, close angle glaucoma, angles glaucoma narrow, closed-angle glaucoma, glaucoma closed angle, narrow-angle glaucoma, ACG - Angle-closure glaucoma, Closed-angle glaucoma, Closed angle glaucoma, Narrow cleft glaucoma, Angle-closure glaucoma (disorder), Angle-closure glaucoma, glaucoma; angle-closure, glaucoma; narrow angle, glaucoma; obstructive, narrow angle; glaucoma, obstructive; glaucoma, angle-closure; glaucoma, Angle Closure Glaucoma |
German | Glaukom Winkelblock, Winkelblockglaukom, Engwinkelglaukom, Glaukom, Winkelblock- |
Swedish | Trångvinkelglaukom |
Japanese | ヘイソクグウカクリョクナイショウ, 閉塞隅角緑内障, 緑内障-閉塞隅角 |
Czech | glaukom s uzavřeným úhlem, Glaukom uzavřeného úhlu, Glaukom s uzavřeným úhlem |
Finnish | Ahdaskulmaglaukooma |
Russian | ZAKRYTOUGOL'NAIA GLAUKOMA, GLAUKOMA ZAKRYTOUGOL'NAIA, ГЛАУКОМА ЗАКРЫТОУГОЛЬНАЯ, ЗАКРЫТОУГОЛЬНАЯ ГЛАУКОМА |
Italian | Glaucoma ad angolo stretto, Glaucoma ad angolo chiuso, Glaucoma non compensato |
Polish | Jaskra zamkniętego kąta |
Hungarian | Zártzugú glaucoma, Csarnokzúg glaucoma, zárt |
Norwegian | Glaukom, ukompensert, Trangvinkelglaukom |
Dutch | gesloten kamerhoek; glaucoom, glaucoom; gesloten kamerhoek, glaucoom; nauwe kamerhoek, glaucoom; obstructief, nauwe kamerhoek; glaucoom, obstructief; glaucoom, kamerhoekblok-glaucoom, Geslotenkamerhoekglaucoom, Glaucoom, geslotenkamerhoek- |
Spanish | glaucoma de ángulo cerrado (trastorno), glaucoma de ángulo cerrado, glaucoma de ángulo estrecho, Glaucoma de ángulo cerrado, Glaucoma de Ángulo Cerrado |
Portuguese | Glaucoma de ângulo fechado, Glaucoma de Ângulo Fechado |
French | Glaucome à angle fermé, Glaucome par fermeture de l'angle irido-cornéen, Glaucome par fermeture de l'angle iridocornéen, Glaucome par fermeture de l'angle, Glaucome à angle étroit |
Ontology: Primary angle-closure glaucoma (C0017606)
Concepts | Disease or Syndrome (T047) |
ICD9 | 365.20, 365.2 |
ICD10 | H40.2 , H40.20 |
SnomedCT | 193547001, 193545009, 193544008, 42456004, 155123006, 270882001, 392288006 |
English | ACG - Angle-closure glaucoma, Primary angle-closure glaucoma NOS, Primary angle-closure glaucoma, unspecified, Primary close-ang.glaucom.unsp, Primary close-ang.glaucoma NOS, primary angle-closure glaucoma (diagnosis), primary angle-closure glaucoma, Primary angle-closure glaucoma, Prim angl-clos glauc NOS, Unspecified primary angle-closure glaucoma, Primary angle-closure glaucoma NOS (disorder), Unspecified primary angle-closure glaucoma (disorder), Primary angle-closure glaucoma (disorder), Primary angle-closure glaucoma, NOS, Primary Angle Closure Glaucoma |
Dutch | primair kamerhoekblok-glaucoom, primair kamerhoekblok-glaucoom, niet-gespecificeerd, Primair gesloten-kamerhoekglaucoom |
French | Glaucome primitif à angle fermé, Glaucome primitif à angle fermé, non précisé |
German | primaeres Winkelblockglaukom, unspezifisch, primaeres Winkelblockglaukom, Primaeres Engwinkelglaukom |
Italian | Glaucoma primario ad angolo chiuso, non specificato, Glaucoma primario ad angolo chiuso |
Portuguese | Glaucoma de ângulo fechado primário, Glaucoma de ângulo fechado primário NE |
Spanish | Glaucoma primario de ángulo cerrado, Glaucoma de ángulo cerrado primario no especificado, glaucoma primario de cierre de ángulo, glaucoma de ángulo agudo, glaucoma primario de ángulo cerrado, SAI, glaucoma primario de ángulo estrecho, glaucoma primario de ángulo cerrado, no especificado, glaucoma primario de cierre de ángulo (concepto no activo), glaucoma primario de ángulo cerrado, no especificado (trastorno), glaucoma primario de ángulo estrecho (trastorno), glaucoma primario de ángulo cerrado, SAI (trastorno), glaucoma primario de ángulo agudo (trastorno), glaucoma primario de ángulo agudo |
Japanese | 原発閉塞隅角緑内障, 原発性閉塞隅角緑内障、詳細不明, ゲンパツヘイソクグウカクリョクナイショウ, ゲンパツセイヘイソクグウカクリョクナイショウショウサイフメイ |
Czech | Blíže neurčený primární glaukom s uzavřeným úhlem, Primární glaukom s uzavřeným úhlem |
Korean | 원발성 폐쇄우각 녹내장 |
Hungarian | Primaer zártzugú glaucoma, nem meghatározott, Primaer zártzugú glaucoma |