Updated Acute Angle-Closure Glaucoma

Abstract

Acute angle-closure glaucoma is an ophthalmic emergency caused by rapidly rising of the intraocular pressure. The etiology is from obstruction of trabecular meshwork resulting in the closure of anterior chamber angle. This condition can cause permanent visual if not treated promptly. The main risk factor is the narrow anterior chamber angle and shallow anterior chamber depth. In addition the risks of angle closure are also high among the women, the elderly, Asian population and those with hyperopia. The patients usually present with acute severe painful blurred vision, red eye, seeing rainbow halos around lights, nausea, vomiting and headache. Ocular examination shows high IOP, hazy cornea from cornea edema, shallow anterior chamber, closed anterior chamber angle, anterior lens position, fixed semi-dilatation of the pupil and occasionally, optic disc edema. The treatment in acute stage is immediate IOP reduction and reopen the angle by medication, laser and/or lens extraction with goniosynechialysis. Trabeculectomy is performed in cases of uncontrolled IOP after reopening of the angle as long term management. The evaluation and prophylaxis laser treatment are also needed to prevent the acute angle closure in fellow eyes.