Last reviewed: 22 Dec 2021
Last updated: 02 Jul 2019



History and exam

Key diagnostic factors

  • presence of risk factors
  • halos around lights
  • aching eye or brow pain
  • headache
  • nausea, vomiting
  • reduced visual acuity
  • eye redness
  • elevated intraocular pressure (IOP)
  • corneal oedema
  • fixed dilated pupil

Other diagnostic factors

  • incidental eye findings
  • blurred vision
  • change in vision

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

Diagnostic investigations

1st investigations to order

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

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's retinal tomography
  • GDx nerve fibre analyser

Treatment algorithm



Ani Khondkaryan, MD

Associate Clinical Professor

Department of Ophthalmology

Keck School of Medicine

University of Southern California

Los Angeles



AK declares that she has no competing interests.

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



BAF is a consultant for Diopsys, Endo Optiks, Glaukos, NeoMedix, and Bausch Health. BAF is a speaker for Bausch + Lomb, and has given expert opinion to Valentine Law Group and Reback, McAndrews, Kjar, Warford & Stockalper, LLP.


Dr Ani Khondkaryan and Dr Brian A. Francis would like to gratefully acknowledge Dr Yaniv Barkana and Dr Noa Chetrit, previous contributors to this topic. 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




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




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

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