Summary
Definition
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
- corneal hysteresis
- 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
- corneal hysteresis
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
Emerging tests
- corneal hysteresis
Treatment algorithm
initial presentation: acute angle-closure glaucoma
initial presentation: chronic angle-closure glaucoma
residual angle closure after laser peripheral iridotomy with elevated intra-ocular 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
Disclosures
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
Disclosures
EJR has received one honorarium from Pfizer, Inc. (manufacturers of Xalatan) for a speaking engagement.
Differentials
- Open-angle glaucoma (primary and secondary)
- Other optic neuropathies (e.g., compressive)
- Eye trauma
More DifferentialsGuidelines
- Glaucoma summary benchmarks - 2023
- Vision rehabilitation preferred practice pattern
More GuidelinesPatient information
Glaucoma (open angle)
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