Angle-closure glaucoma

Last reviewed: 6 Sep 2022
Last updated: 28 Sep 2022

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
More key diagnostic factors

Other diagnostic factors

  • use of medications that induce angle narrowing
  • incidental eye findings
  • blurred vision
  • 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
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

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

Ani Khondkaryan, MD

Assistant Chief of Service

Department of Ophthalmology

Panorama City/Santa Clarita Kaiser Permanente

Los Angeles

CA

Disclosures

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

CA

Disclosures

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.

Acknowledgements

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

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.

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