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Angle-closure glaucoma

Last reviewed: 14 Aug 2025
Last updated: 20 Nov 2024

Summary

Definition

History and exam

Key diagnostic factors

  • halos around lights
  • aching eye or brow pain
  • headache
  • nausea, vomiting
  • reduced visual acuity
  • eye redness
  • elevated intraocular pressure (IOP)
  • corneal edema
  • fixed dilated pupil
Full details

Other diagnostic factors

  • use of medications that induce angle narrowing
  • incidental eye findings
  • blurred vision
  • corneal hysteresis
  • change in vision
Full details

Risk factors

  • female sex
  • hyperopia
  • shallow peripheral anterior chamber
  • second eye having angle closure
  • Inuit and Asian ethnicity
  • advanced age
  • family history
  • use of medications that induce angle narrowing
  • corneal hysteresis
Full details

Diagnostic investigations

1st investigations to order

  • gonioscopy, examination of anterior chamber angle
  • slit lamp examination
  • automatic static perimetry
Full details

Investigations to consider

  • ultrasound biomicroscopy
  • anterior segment optical coherence tomography (of angle)
  • evaluation of the optic nerve head by fundoscopy
  • retinal optical coherence tomography
  • Heidelberg retinal tomography
  • GDx nerve fiber analyzer
Full details

Emerging tests

  • corneal hysteresis

Treatment algorithm

ACUTE

initial presentation: acute angle-closure glaucoma

initial presentation: chronic angle-closure glaucoma

ONGOING

residual angle closure after laser peripheral iridotomy with elevated intraocular pressure

repeat episode of acute angle-closure glaucoma

Contributors

Authors

Brian A. Francis, MD, MS

Riffenburgh Professorship in Glaucoma

Associate Professor of Ophthalmology

Doheny Eye Institute

Department of Ophthalmology

Keck School of Medicine

University of Southern California

Los Angeles

CA

Disclosures

BAF declares that he has no competing interests.

Stephanie Midtling, MD

Glaucoma Fellow

Department of Ophthalmology

UCLA Stein Eye Institute

Doheny Eye Centers UCLA

Los Angeles

CA

Disclosures

SM declares that she has no competing interests.

Acknowledgements

Dr Brian A. Francis and Dr Stephanie Midtling would like to gratefully acknowledge Dr Ani Khondkaryan, Dr Yaniv Barkana, and Dr Noa Chetrit, previous contributors to this topic. AK, YB, and NC declare that they have no competing interests.

Peer reviewers

Gus Gazzard, MA, MBBChir, MD, FRCOphth

Consultant Ophthalmic Surgeon

King's College Hospital

Honorary Research Fellow

Institute of Ophthalmology

London

UK

Declarações

GG declares that he has no competing interests.

Edward J. Rockwood, MD

Associate Professor of Ophthalmology

Cleveland Clinic Lerner College of Medicine of Case Western Reserve University

Cole Eye Institute

Cleveland Clinic

Cleveland

OH

Declarações

EJR has received one honorarium from Pfizer, Inc. (manufacturers of Xalatan) for a speaking engagement.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

American Academy of Ophthalmology. Preferred practice pattern: primary angle closure. November 2020 [internet publication].Texto completo

International Council of Ophthalmology. ICO guidelines for glaucoma eye care. February 2016 [internet publication].Texto completo

American Academy of Ophthalmology. ​Glaucoma summary benchmarks - 2023. Dec 2023 [internet publication].Texto completo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
  • Diagnósticos diferenciais

    • Open-angle glaucoma (primary and secondary)
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  • Diretrizes

    • Glaucoma summary benchmarks​ - 2023
    • Vision rehabilitation preferred practice pattern
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  • Folhetos informativos para os pacientes

    Glaucoma (open angle)

    Mais Folhetos informativos para os pacientes
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