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Emergency: requires immediate attention
Acute angle-closure glaucoma - External and Internal Eye
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Emergency: requires immediate attention

Acute angle-closure glaucoma - External and Internal Eye

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Contributors: Rachel Ellis MD, Andrew Goodfriend MD, Lauren Patty Daskivich MD, MSHS
Other Resources UpToDate PubMed

Synopsis

Angle-closure glaucoma (ACG) is an uncommon but emergent condition; although far less common than open-angle glaucoma, it has a much greater chance of causing permanent vision loss due to its acute nature. Individuals of Northern European descent have a 0.1% incidence of acute ACG, while those of Inuit or Eskimo descent have up to 40 times this rate. ACG is also more common in persons aged 55-70, women, those of Asian descent, individuals with hyperopia / smaller eyes, and those with a family history of the disease. People who have had ACG in one eye are also more likely to get it in the other eye. Many drugs, including anticholinergic agents, tricyclic antidepressants, selective serotonin reuptake inhibitors, and adrenergic agonists, can precipitate ACG by shifting the lens iris diaphragm anteriorly.

An attack of acute ACG occurs when there is a sudden obstruction of aqueous humor outflow through the drainage angle of the eye, causing a rapid increase in intraocular pressure (IOP). Primary angle closure may be caused by pupillary block or angle crowding or both. Pupillary block occurs when the increased iris convexity brings the iris into apposition with the trabecular meshwork, thereby blocking drainage of the aqueous fluid. With angle-crowding mechanism, anteriorly positioned ciliary processes push the iris anteriorly so that the peripheral iris lies against the trabecular meshwork. Secondary angle closures are associated with angle blockage from other ocular diseases such as iris neovascularization, uveitis, trauma, tumors, ectopic lens, cataract, or lens protein leakage.

Patients often present with acute onset of extremely painful, decreased vision associated with a red eye and a mid-dilated pupil. Headache, seeing rainbow-colored halos around lights, nausea, and vomiting are also commonly present. There may be a recent history of physiologic (ie, being in a dark room) or pharmacologic pupillary dilation.

Codes

ICD10CM:
H40.219 – Acute angle-closure glaucoma, unspecified eye

SNOMEDCT:
30041005 – Acute angle-closure glaucoma

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed: 08/23/2019
Last Updated: 08/29/2019
Copyright © 2019 VisualDx®. All rights reserved.
Emergency: requires immediate attention
Acute angle-closure glaucoma - External and Internal Eye
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Acute angle-closure glaucoma : Eye pain, Headache, Nausea/vomiting, Afferent pupillary defect, Corneal edema, Ocular hypertension, Shallow anterior chamber, Mydriasis, Blurry vision
Clinical image of Acute angle-closure glaucoma
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