Acute Angle-Closure Glaucoma Management

Clinical Presentation

The American Academy of Ophthalmology notes that acute angle-closure glaucoma is characterized by symptoms including blurred vision, halos around lights, eye pain, headache, eye redness, corneal edema, a mid-dilated pupil, and potentially nausea and vomiting, which require immediate medical attention to prevent vision loss 1, 2
Pressure-induced corneal edema is experienced as blurred vision and halos around lights, according to the American Academy of Ophthalmology 1, 3
Eye pain and headache are common symptoms of acute angle-closure crisis, as reported by the American Academy of Ophthalmology 3, 4
Nausea and vomiting may occur in patients with acute angle-closure crisis, as noted by the American Academy of Ophthalmology 3
Decreased vision is a potential symptom of acute angle-closure crisis, according to the American Academy of Ophthalmology 3

The American Academy of Ophthalmology identifies Asian descent as a risk factor for angle-closure glaucoma 2
Hyperopia is a risk factor for angle-closure glaucoma, as reported by the American Academy of Ophthalmology 4
Older age, typically over 50 years, is a risk factor for angle-closure glaucoma, according to the American Academy of Ophthalmology 1, 2
Female gender is a risk factor for angle-closure glaucoma, as noted by the American Academy of Ophthalmology 2
Short axial length is a risk factor for angle-closure glaucoma, according to the American Academy of Ophthalmology 2, 4
Thick and anteriorly positioned crystalline lens is a risk factor for angle-closure glaucoma, as reported by the American Academy of Ophthalmology 2, 4
Shallow anterior chamber depth is a risk factor for angle-closure glaucoma, according to the American Academy of Ophthalmology 4
Steep corneal curvature is a risk factor for angle-closure glaucoma, as noted by the American Academy of Ophthalmology 4
Family history of angle-closure glaucoma is a risk factor, as reported by the American Academy of Ophthalmology 3

Initial medical therapy to lower IOP and relieve symptoms in acute angle-closure crisis includes topical beta-adrenergic antagonists, topical alpha2-adrenergic agonists, topical carbonic anhydrase inhibitors, topical parasympathomimetics, and oral or intravenous hyperosmotic agents, as recommended by the American Academy of Ophthalmology 5, 6
Definitive treatment once IOP is controlled includes laser peripheral iridotomy (LPI), surgical iridectomy, and laser iridotomy in the fellow eye to prevent AACC, according to the American Academy of Ophthalmology 5, 6
For chronic primary angle-closure glaucoma, treatment includes LPI, post-iridotomy management with topical ocular hypotensive agents, laser iridoplasty, lens extraction, and incisional glaucoma surgery, as recommended by the American Academy of Ophthalmology 5, 6

Delayed diagnosis can lead to permanent vision loss, with 18% of eyes becoming blind and 48% developing glaucomatous optic neuropathy within 4-10 years following an untreated AACC, as reported by the American Academy of Ophthalmology 4
Verify iridotomy patency after LPI, as recommended by the American Academy of Ophthalmology 6
Monitor for persistent IOP elevation after LPI, according to the American Academy of Ophthalmology 6
Consider lens extraction, as growing evidence shows that cataract extraction alone may lead to substantial IOP lowering in PAC and PACG patients, as noted by the American Academy of Ophthalmology 5, 6
Recognize plateau iris, as some patients may have plateau iris configuration that persists after iridotomy, according to the American Academy of Ophthalmology 1, 2

Confirm patency of iridotomy, as recommended by the American Academy of Ophthalmology 6
Measure IOP, according to the American Academy of Ophthalmology 6
Perform dark-room gonioscopy with compression/indentation to assess the extent of PAS, as recommended by the American Academy of Ophthalmology 6
Examine the fundus as clinically indicated, according to the American Academy of Ophthalmology 6
Prescribe topical corticosteroids in the postoperative period after laser treatment, as recommended by the American Academy of Ophthalmology 6