Angle Closure Glaucoma

Angle closure glaucoma is a disorder of progressive optic nerve damage characterized by an increased intraocular pressure. Obstruction of aqueous humor flow in the anterior chamber causes sudden vision impairment and headaches. A rapid diagnosis is necessary, as blindness can occur without adequate treatment.


The clinical presentation of angle closure glaucoma stems from sudden increases in intraocular pressure (IOP), with possible triggers being dim lighting or use of drugs that induce pupillary dilation (eg. anticholinergics), ciliary body swelling (eg. topiramate) [1]. Moreover, anterior placement of the lens (most commonly caused by the gradual development of cataract) [2], myopia, hyperopia, a shallow anterior chamber, but also advanced age and female gender have all been established as potential risk factors for this type of glaucoma [3] [4]. Only about a third of cases develop an acute exacerbation of IOP changes, however, but increased IOP may not cause marked eye-related symptoms in the beginning [5]. Unfortunately, patients frequently report when profound visual deficits have already occurred, especially in chronic forms, thus reducing the chance of total sight repair [4] [5]. Most prominent symptoms of acute angle closure glaucoma are blurred vision, redness of the eye, ocular discomfort, colored halos around lights and frontal headaches accompanied by nausea and vomiting. Gastrointestinal complaints and headaches may mislead the physician by suggesting a gastrointestinal or central nervous system origin of symptoms [1] [3], and it is not uncommon for glaucoma patients to undergo detailed gastrointestinal or CNS workup prior to their diagnosis [2]. In some patients, a prolonged (chronic) clinical course may be observed, distinguished by ocular discomfort and headaches that are alleviated with sleep [1]. In the setting of a delayed diagnosis, irreversible blindness can occur rapidly, which is why early recognition is detrimental in achieving good outcomes [4].

  • more...
  • Eyes
    Eye Pain
    • Our case is remarkable because of the clear temporal relationship between development of acute eye pain and the rapid drop in plasma glucose levels.[]
    • Acute angle-closure (closed-angle or narrow-angle) glaucoma produces symptoms such as eye pain , headaches, halos around lights, dilated pupils , vision loss, red eyes , nausea and vomiting.[]
    • Some early symptoms in people at risk for angle-closure glaucoma include blurred vision, halos in their vision, headache, mild eye pain or redness. People who are at risk for developing angle-closure glaucoma should have a laser iridotomy.[]
    • Symptoms of angle-closure glaucoma may include headaches, eye pain, nausea, rainbows around lights at night, and very blurred vision.[]
    • Acute Angle-Closure Glaucoma Symptom Eye Pain Eye pain is often described as burning, sharp, shooting, dull, gritty, a feeling of "something in my eye," aching, pressure, throbbing, or stabbing.[]
    Blurred Vision
    • Dramatic symptoms of acute angle-closure glaucoma include the following: Severe eye pain Nausea and vomiting Headache Blurred vision and/or seeing haloes around lights (Haloes and blurred vision occur because the cornea is swollen.)[]
    • Some early symptoms in people at risk for angle-closure glaucoma include blurred vision, halos in their vision, headache, mild eye pain or redness. People who are at risk for developing angle-closure glaucoma should have a laser iridotomy.[]
    • Symptoms of angle-closure glaucoma may include headaches, eye pain, nausea, rainbows around lights at night, and very blurred vision.[]
    • When symptoms of acute angle glaucoma do develop, they may include severe eye and facial pain, nausea and vomiting , decreased vision, blurred vision and seeing haloes around light.[]
    • This may cause pressure-induced corneal edema (experienced as blurred vision and occasionally as multicolored halos around lights) vascular congestion, eye pain, or headache. High IOP may be accompanied by nausea and vomiting.[]
  • more...
  • psychiatrical
  • more...
  • musculoskeletal
    Decrease in Height
    • Decreased corneal height. 40. 08/22/15 7.Anterior position of the lens with respect to the ciliary body. 8. Increased curvature of the anterior lens surface. 9. Increased thickness of the lens. 10.[]
  • more...
  • neurologic
  • more...
  • Face, Head & Neck
    Facial Pain
    • When symptoms of acute angle glaucoma do develop, they may include severe eye and facial pain, nausea and vomiting , decreased vision, blurred vision and seeing haloes around light.[]
  • more...
  • Entire body system
  • more...
  • Workup

    Patients must be promptly evaluated through a detailed examination of the eye [5]. IOP of more than 30 mmHg (physiological range is between 10 and 23 mmHg) is encountered in virtually all patients suffering from glaucoma, while other findings include a fixed mid-dilated pupil (4-6 mm) that reacts poorly to direct illumination, a hazy cornea that may be edematous, hyperemia of the conjunctiva and a shallow anterior chamber [3]. The presence of adhesions between the iris and the angle structure, termed peripheral anterior synechiae (PAS), can cause obstruction of the trabecular meshwork and are frequently encountered in angle closure glaucoma patients as well [3]. These findings can be confirmed either by performing gonioscopy or through a slit-lamp examination [5], while more specialized techniques have been developed to confirm angle closure. Ultrasound biomicroscopy, which is able to acquire real-time images of structures that potentially cause obstruction of the canal, and anterior segment optical coherence tomography, used to evaluate the anterior chamber, are imaging methods that are recommended for glaucoma workup by more skilled ophthalmologists [5].


  • more...
  • Microbiology
  • more...
  • Test Results

    Ocular Tonometry
  • more...
  • Visual Field Test
  • more...
  • Treatment



    Loss of Vision
    • In some patients, the loss of vision occurs very slowly and treatment may not be necessary. However, most patients do require treatment. This prevents or slows further loss of vision in most patients.[]
    • Immediate treatment is needed to relieve symptoms and to prevent permanent loss of vision (severe sight impairment).[]
    • An acute attack is a medical emergency and requires immediate treatment to prevent permanent loss of vision. A prolonged attack without treatment will result in permanent damage to the optic nerve, impairing vision.[]
    • PACG is often missed in these populations, and efforts must be taken to identify it so that needless loss of vision is avoided.[]
    • Complications These include permanent loss of vision, repetition of the acute attack, attack in the fellow eye and central retinal artery or vein occlusion. Prognosis In an uncomplicated case of primary AACG, the outlook is excellent.[]
    • Types of Glaucoma Open-angle glaucoma Angle-closure glaucoma Neovascular glaucoma Pigmentary glaucoma Pseudoexfoliation glaucoma Inflammatory glaucoma Open-angle Glaucoma Primary open-angle glaucoma is the most common form of glaucoma in America and Europe[]
    • Open-angle glaucoma; Chronic glaucoma; Chronic open-angle glaucoma; Primary open-angle glaucoma; Closed-angle glaucoma; Narrow-angle glaucoma; Angle-closure glaucoma; Acute glaucoma; Secondary glaucoma; Congenital glaucoma; Vision loss - glaucoma Glaucoma[]
    • In the United States, fewer than 10% of glaucoma cases are due to angle-closure glaucoma. In Asia, angle-closure glaucoma is more common than open-angle glaucoma.[]
    • The detection of secondary angle closure glaucoma, like other forms of symptomless glaucoma, depends on regular routine eye examinations which include all three glaucoma tests .[]
    • (See also Overview of Glaucoma .) Angle-closure glaucoma accounts for about 10% of all glaucomas in the US.[]
    Secondary Glaucoma
    • SECONDARY GLAUCOMA If you have secondary glaucoma, treating the cause may help your symptoms go away. Other treatments also may be needed. Outlook (Prognosis) Open-angle glaucoma cannot be cured.[]
    • Keywords: angle closure glaucoma, plateau iris, topiramate, secondary glaucoma, drug-induced glaucoma This work is published and licensed by Dove Medical Press Limited.[]
    • During these visits, make sure you ask the optometrist (optician) to carry out the three glaucoma tests In all forms of secondary glaucoma the underlying condition is addressed if possible, and because the loss of vision in glaucoma is permanent, glaucoma[]
    • Other types of glaucoma include: acute angle closure glaucoma – an uncommon type caused by the drainage in the eye becoming suddenly blocked, which can raise the pressure inside the eye very quickly secondary glaucoma – caused by an underlying eye condition[]
    • Sometimes the stomach problem is so prominent that people go to an emergency room and the staff pays attention to that, thinking it is appendicitis, before realizing that the eye is the cause.[]
    Interstitial Keratitis
    • keratitis — Posterior (pushing mechanism) With pupillary block Lens-induced mechanisms Intumescent lens Subluxation of lens Mobile lens syndrome Posterior synechiae Iris-vitreous block in aphakia Pseudophakia Uveitis Pupillary block glaucoma — Without[]



    Sex distribution
    Age distribution




    Patient Information

    Other symptoms

    • Gastrointestinal agents Cimetidine and ranitidine, H2-blocker agents, have weak anticholinergic adverse effects, which may induce AACG. Drug-induced AACG may be preventable if patients at risk are recognized and treated with prophylactic iridotomy.[]
    • Some medicines used to treat allergies or stomach ulcers, such as chlorphenamine , cimetidine and ranitidine . Medication used during a general anaesthetic. Who develops acute angle-closure glaucoma (AACG)? About 1 in 1,000 people develop AACG.[]
    • In addition, it is postulated that the zonule becomes more lax with age, allowing anterior movement of the lens/iris diaphragm.[]
    Iridocorneal Adhesions
    • Posterior polymorphous dystrophy Glaucoma occurs in 10–15% of patients -presents with corneal edema, iris atrophy, mild corectopia, and iridocorneal adhesions -maintain good vision throughout lives -cluster or linear arrangement of vesicles in the posterior[]


    Ask Question

    5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.


    1. Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J; 2011.
    2. Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 18e. New York, NY: McGraw-Hill; 2012.
    3. Pokhrel PK, Loftus SA. Ocular emergencies. Am Fam Physician. 2007;76(6):829.
    4. Azuara-Blanco A, Burr J, Ramsay C, Cooper D, Foster PJ, Friedman DS, et al. Effectiveness of early lens extraction for the treatment of primary angle-closure glaucoma (EAGLE): a randomised controlled trial. Lancet. 2016;388(10052):1389-1397.
    5. Weinreb RN, Aung T, Medeiros FA. The Pathophysiology and Treatment of Glaucoma: A Review. JAMA. 2014;311(18):1901-1911.

    1. Acute angle-closure glaucoma: the second eye: an analysis of 200 cases - RF Lowe - The British Journal of Ophthalmology, 1962 -
    2. Aetiology of the anatomical basis for primary angle-closure glaucoma. Biometrical comparisons between normal eyes and eyes with primary angle-closure glaucoma. - RF Lowe - The British journal of ophthalmology, 1970 -
    3. An ultrasound biomicroscopic analysis of angle-closure glaucoma secondary to ciliochoroidal effusion in IgA nephropathy. - CJ Pavlin, M Easterbrook, K Harasiewicz - American journal of , 1993 -
    4. Angle-closure glaucoma in an urban population in southern India: the Andhra Pradesh Eye Disease Study - L Dandona, R Dandona, P Mandal - , 2000 -
    5. Acute angle-closure glaucoma following botulinum toxin injection for blepharospasm. - P Corridan, S Nightingale, N Mashoudi - British journal of , 1990 -
    6. Acute myopia and angle-closure glaucoma induced by topiramate - M Boentert, H Aretz, P Ludemann - Neurology, 2003 - AAN Enterprises
    7. Severity and spatial distribution of visual field defects in primary glaucoma: a comparison of primary open-angle glaucoma and primary angle-closure glaucoma - G Gazzard, PJ Foster, AC Viswanathan - Archives of , 2002 - Am Med Assoc
    8. Acute angle closure glaucoma associated with nebulised ipratropium bromide and salbutamol. - P Shah, L Dhurjon, T Metcalfe - BMJ: British Medical , 1992 -
    9. Five‐year risk of progression of primary angle closure to primary angle closure glaucoma: a population‐based study - R Thomas, R Parikh, J Muliyil - Acta Ophthalmologica , 2003 - Wiley Online Library
    10. Anterior chamber depth measurement as a screening tool for primary angle-closure glaucoma in an East Asian population - JG Devereux, PJ Foster, J Baasanhu - Archives of , 2000 - Am Med Assoc