II. Epidemiology

  1. Relatively rare compared with Open Angle Glaucoma

III. Risk factors

  1. Increasing age
  2. Hyperopia (Far-sightedness)
  3. Family History of Glaucoma
  4. Angle closure Glaucoma in contralateral eye
  5. Pupillary dilation
  6. Anatomic variant with shallow anterior chamber

IV. Causes: Precipitating Factors

  1. Dim lighting (results in Mydriasis of the pupil)
  2. Eye Dilating Drops (Mydriatics)
  3. Ophthalmic Anticholinergic agents
  4. Systemic medications (cause ciliary body edema)
    1. Antidepressants
    2. Sulfa-based medications
    3. Topiramate

V. Pathophysiology

  1. Drainage obstruction of aqueous from anterior chamber
    1. Physical blockage of outflow tract by iris
    2. Narrowing of anterior chamber angle
  2. Increased aqueous production

VI. Symptoms

  1. Acute (Usual presentation)
    1. Decreased Visual Acuity or blurred vision
      1. Severe Vision Loss in hours to days
    2. Photophobia
    3. Headache
    4. Extreme Eye Pain
    5. Nausea and Vomiting
    6. Abdominal discomfort
  2. Sub-acute
    1. Mild Eye Pain
    2. Visual changes
      1. Colored halos seen around streetlights
        1. Results from Corneal edema
      2. Tunnel vision
    3. Headache

VII. Signs

  1. Shallow Anterior Chamber Depth
  2. Decreased Visual Acuity
  3. Pupil mildly dilated and sluggishly reactive
  4. Globe feels firm or rock-hard on palpation through lid
  5. Increased Intraocular Pressure = 25 - 50 mmHg
  6. Eye Redness
  7. Conjunctival edema (Chemosis)
  8. Corneal edema
    1. Cornea cloudy, "steamy", hazy
  9. Ciliary Flush
  10. Fundoscopy
    1. Optic disc cupping

VIII. Differential Diagnosis

  1. Open Angle Glaucoma
  2. Narrow Angle Glaucoma often misdiagnosed as:
    1. Migraine Headache
    2. Gastroenteritis

IX. Management

  1. Immediate ophthalmology referral
  2. Treat both eyes (typically progresses to involve both eyes)
  3. Temporizing measures
    1. Give Acetazolamide 500 mg orally or IV AND
    2. Administer all 3 ophthalmic medications (repeated every 5 minutes for 3 doses)
      1. Timolol maleate 0.5% (Timoptic) AND
      2. Apraclonidine 1% (Iopidine) given 1 minute after Timolol AND
      3. Pilocarpine 2% (Isoptocarpine) given 1 minute after Apraclonidine
        1. Pilocarpine is only effective after lowering eye pressure with Timolol (due to ischemic paralysis of the iris)
    3. Monitor Intraocular Pressure hourly until patient is seen by ophthalmology
  4. Surgery (definitive treatment)
    1. Laser iridotomy
    2. Iridectomy

Images: Related links to external sites (from Google)

Ontology: Angle Closure Glaucoma (C0017605)

Definition (MSH) A form of glaucoma in which the intraocular pressure increases because the angle of the anterior chamber is blocked and the aqueous humor cannot drain from the anterior chamber.
Concepts Disease or Syndrome (T047)
MSH D015812
SnomedCT 392291006, 33647009, 270882001, 193544008
English Closure-angle glaucoma, Angle-closure glaucoma, primary, Angle Closure Glaucomas, Angle-Closure Glaucoma, Angle-Closure Glaucomas, Closed-Angle Glaucoma, Closed-Angle Glaucomas, Glaucoma, Angle Closure, Glaucoma, Angle-Closure, Glaucoma, Closed Angle, Glaucoma, Closed-Angle, Glaucoma, Narrow-Angle, Glaucoma, Uncompensated, Glaucoma, Uncompensative, Glaucomas, Angle Closure, Glaucomas, Angle-Closure, Glaucomas, Closed-Angle, Glaucomas, Narrow-Angle, Glaucomas, Uncompensated, Glaucomas, Uncompensative, Narrow-Angle Glaucoma, Narrow-Angle Glaucomas, Uncompensated Glaucoma, Uncompensated Glaucomas, Uncompensative Glaucoma, Uncompensative Glaucomas, NARROW ANGLE GLAUCOMA, GLAUCOMA, CLOSED ANGLE, GLAUCOMA, NARROW ANGLE, GLAUCOMA, OBSTRUCTIVE, Glaucoma, Narrow Angle, Glaucoma, angle-closure, ACG - Angle closure glaucoma, Narrow angle glaucoma, Narrow-angle glaucoma, closed angle glaucoma, narrow angle glaucoma, angle-closure glaucoma (diagnosis), angle-closure glaucoma, Angle glaucoma closed, Glaucoma closed angle, Angle closure glaucoma, GLAUCOMA NARROW ANGLE, Glaucoma, Angle-Closure [Disease/Finding], angle closure glaucoma, glaucoma angle-closure, narrow glaucoma angle, glaucoma narrow angle, close angle glaucoma, angles glaucoma narrow, closed-angle glaucoma, glaucoma closed angle, narrow-angle glaucoma, Narrow cleft glaucoma, Angle-closure glaucoma (disorder), Angle-closure glaucoma, glaucoma; angle-closure, glaucoma; narrow angle, glaucoma; obstructive, narrow angle; glaucoma, obstructive; glaucoma, angle-closure; glaucoma, ACG - Angle-closure glaucoma, Closed-angle glaucoma, Closed angle glaucoma, Angle Closure Glaucoma
German Glaukom Winkelblock, Winkelblockglaukom, Engwinkelglaukom, Glaukom, Winkelblock-
Swedish Trångvinkelglaukom
Japanese ヘイソクグウカクリョクナイショウ, 閉塞隅角緑内障, 緑内障-閉塞隅角
Czech glaukom s uzavřeným úhlem, Glaukom uzavřeného úhlu, Glaukom s uzavřeným úhlem
Spanish Closed-angle glaucoma, Closed angle glaucoma, glaucoma de ángulo cerrado (trastorno), glaucoma de ángulo cerrado, glaucoma de ángulo estrecho, Glaucoma de ángulo cerrado, Glaucoma de Ángulo Cerrado, Glaucoma de Angulo Cerrado
Finnish Ahdaskulmaglaukooma
Russian ZAKRYTOUGOL'NAIA GLAUKOMA, GLAUKOMA ZAKRYTOUGOL'NAIA, ГЛАУКОМА ЗАКРЫТОУГОЛЬНАЯ, ЗАКРЫТОУГОЛЬНАЯ ГЛАУКОМА
Italian Glaucoma ad angolo stretto, Glaucoma ad angolo chiuso, Glaucoma non compensato
Polish Jaskra zamkniętego kąta
Hungarian Zártzugú glaucoma, Csarnokzúg glaucoma, zárt
Dutch gesloten kamerhoek; glaucoom, glaucoom; gesloten kamerhoek, glaucoom; nauwe kamerhoek, glaucoom; obstructief, nauwe kamerhoek; glaucoom, obstructief; glaucoom, kamerhoekblok-glaucoom, Geslotenkamerhoekglaucoom, Glaucoom, geslotenkamerhoek-
Portuguese Glaucoma de ângulo fechado, Glaucoma de Ângulo Fechado
French Glaucome à angle fermé, Glaucome par fermeture de l'angle irido-cornéen, Glaucome par fermeture de l'angle iridocornéen, Glaucome par fermeture de l'angle, Glaucome à angle étroit