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Angle-closure glaucoma

Last reviewed: 28 Oct 2023
Last updated: 10 Nov 2023



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
More key diagnostic factors

Other diagnostic factors

  • use of medications that induce angle narrowing
  • incidental eye findings
  • blurred vision
  • corneal hysteresis
  • change in vision
Other diagnostic factors

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
More risk factors

Diagnostic investigations

1st investigations to order

  • gonioscopy, examination of anterior chamber angle
  • slit lamp examination
  • automatic static perimetry
More 1st investigations to order

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
More investigations to consider

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 intraocular pressure

repeat episode of acute angle-closure glaucoma



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.

Stephanie Midtling, MD

Glaucoma Fellow

Department of Ophthalmology

UCLA Stein Eye Institute

Doheny Eye Centers UCLA

Los Angeles



SM declares that she has no competing interests.


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




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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