Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- halos ao redor de luzes
- dor no olho ou na sobrancelha
- cefaleia
- náuseas e vômitos
- acuidade visual reduzida
- vermelhidão no olho
- pressão intraocular elevada (PIO)
- edema da córnea
- pupila dilatada fixa
Other diagnostic factors
- achados oculares acidentais
- visão turva
- histerese da córnea
- alteração na visão
Risk factors
- sexo feminino
- hiperopia
- câmara anterior periférica rasa
- fechamento angular no segundo olho
- etnias inuíte e asiática
- idade avançada
- história familiar
- uso de medicamentos que induzem o estreitamento do ângulo
- histerese da córnea
Diagnostic investigations
1st investigations to order
- gonioscopia, exame do ângulo da câmara anterior
- exame com lâmpada de fenda
- perimetria estática automática
Investigations to consider
- biomicroscopia ultrassônica
- tomografia de coerência óptica do segmento anterior (do ângulo)
- avaliação da cabeça do nervo óptico por fundoscopia
- tomografia de coerência óptica retiniana
- tomografia retiniana de Heidelberg
- analisador de fibras nervosas GDx
Emerging tests
- histerese da córnea
Treatment algorithm
apresentação inicial: glaucoma agudo de ângulo fechado
apresentação inicial: glaucoma crônico de ângulo fechado
fechamento angular residual após iridotomia periférica a laser com pressão intraocular elevada
episódio repetido de glaucoma agudo de ângulo fechado
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.
References
Key articles
American Academy of Ophthalmology. Preferred practice pattern: primary angle closure. November 2020 [internet publication].Full text
International Council of Ophthalmology. ICO guidelines for glaucoma eye care. February 2016 [internet publication]Full text
American Academy of Ophthalmology. Glaucoma summary benchmarks - 2023. Dec 2023 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Glaucoma de ângulo aberto (primário e secundário)
- Outras neuropatias ópticas (por exemplo, compressiva)
- Trauma ocular
More DifferentialsGuidelines
- Glaucoma summary benchmarks - 2023
- Vision rehabilitation preferred practice pattern
More GuidelinesPatient information
Glaucoma (ângulo aberto)
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