Narrow angle Glaucoma

Narrow Angle Glaucoma

• Elevated Pressure
• Damaged Optic Nerve
• Trabecular Meshwork with blocked drainage
• Blocked Fluid Flow

Angle-Closure Glaucoma

Definition: ACG

It is defined as an optic neuropathy which occurs as a result of high intraocular pressure due to narrow or closed angles.

Angle-Closure Glaucoma: High-Risk Groups

• Elderly

• Hyperopic patients

• Positive family history of angle closure

• Females

• Age: after 40 yrs

• Gender: Female:Male::4:1

• Race

  • prevalence higher in South-East Asians, Chinese & Eskimos

• Family history

  • first-degree relatives are at increased risk (≈ 3.5 times)

• Hypermetropes

Acute Angle-Closure Glaucoma is an Emergency

Precipitating Factors

• Dim illumination
• Emotional Stress
• Trauma/illness
• Intense concentration
• Pharmacological pupil dilatation

Clinical Picture

Onset: 50+ years of age

Symptoms

• Severe eye/headache pain
• Blurred vision
• Red eye
• Nausea and vomiting
• Halos around lights
• Intermittent eye ache at night

Signs

• Red, teary eye
• Corneal edema
• Closed angle
• Shallow AC
• Mid-dilated, fixed pupil
• Iris atrophy
• AC inflammation

Symptoms and Diagnosis

• Red eye.
• Hazy cornea.
• Mid-dilated non-reactive pupil.

Acute Angle-Closure Glaucoma

Symptoms and Diagnosis

• Closed angles on gonioscopy
• High IOP over 60 or 70 mm Hg
• Cellular reaction in anterior chamber

Treatment

• Principle of therapy is to bring down the IOP as quickly as possible

• Admit the patient

• Counsel the patient to make her anxiety-free as far as possible

• Give IOP lowering drugs

• Reduce inflammation

• LASER therapy

• Beta-blockers

• Miotics

• Steroid Eye drops

• IV Acetazolamide (Inj Diamox, 500mg IV) followed by (250 mg tablet TID)

• If IOP is still more than 50mmHg

  • Hyperosmotic agents:
    • Mannitol 20%
      • 1-2 gm/kg given I/V within 30-45 minutes
    • Oral Glycerol 50%----1-1.5 gm/kg
  • Raise serum osmotic pressure and withdraw fluid from the eye, especially from vitreous
  • Vitreous dehydration allows the lens to fall back deepening the AC

Fellow Eye?

• Fellow eye should be treated with Pilocarpine eye drops 1 drop QID
• To be followed by prophylactic LASER Peripheral Iridotomy