Post on 16-Jul-2015
ANGLE CLOSURE GLAUCOMA
-Anira Iqbal
Batch 2011
CLASSIFICATIONAngle-closure
GlaucomaPrimary Secondary
Acute (AACG)
Chronic (CACG)
TERMINOLOGIESPrimary Angle
Closure Disease :Narrow angle of AC
Apposition of peripheral iris against TM Obstruction of aqueous outflow
Primary Angle Closure Glaucoma :
+ Optic Disc(OD) Changes
+ Visual field defects(VFD)
RISK FACTORS
Demographic Anatomic
Age – 60 to 70 y/o
Gender – M:F 1:3
Heredity – Anatomic RF
Race – SE Asians, Chinese, Eskimos >> Blacks
HM– Short axial length,Shallow AC
Iris – lens diaphragmplaced anteriorly
Plateau Iris config.
Narrow angle of AC
Small eyeball Large lens
Smaller D of cornea
Bigger size of CBAnterior insertion of iris on
CB
PATHOGENESIS
Pupillary block mechanism (70%)
Phacomorphic mechanism (20%)
Plateau Iris configuration (10%)
PUPILLARY BLOCK MECHANISM
Precipitating factors :1. Physiological mydriasis – Reading in dim light,
watching tv in dark room, sympathetic overactivity in anxiety/emotional stress.
2. Pharmacological mydriasis• Mydriatics : Phenylephrine, Tropicamide,
Cyclopentolate, Homatropine, Atropine• Tranquilizers• Bronchodilators• Anti-depressants• Vasoconstrictors3 Pharmacological miosis – Echothiophate, Pilocarpine
Mechanism :Mydriasis mild dilatation of pupil Inc apposition
b/w iris and lens Relative Pupillary Block (RPB) Aq. Collects in PC pushes iris anteriorly Iris Bombe contact of iris with cornea Appositional angle closure Inc IOP formation of peripheral ant. Synechiae Synechial angle closure
Miosis contract ciliary muscles Zonules relax lens moves forward contact of iris with lens
PLATEAU IRIS• Also c/d Angle closure Glaucoma without
pupillary block.• Insertion of iris anteriorly on ciliary body or
displacement of ciliary body anteriorly apposition of peripheral iris with TM Plateau iris configuration iridotomy if still acute ACG occurs spontaneously/after pharmacological dilation Plateau iris syndrome Miotics + laser peripheral iridoplasty
CLASSIFICATIONClinical (Based on symptoms)• Latent primary ACG• Subacute/Intermittent PACG• Acute PACG• Chronic PACG
Association of International Glaucoma Societies (AIGS) – (Based on signs) :
• Primary angle closure suspects (PACS) – Latent PACG
• Primary angle closure (PAC) – Subacute + Acute
• Primary angle closure Glaucoma (PACG) - chronic
PACS• Symptoms – Absent• Presenting situations – Glaucoma Screening
Programme Routine ocular
exam Fellow eye in pt of
acute PAC• Signs:1. Eclipse sign
2. Slit lamp biomicroscopy – Dec axial AC depth - Convex shaped iris-
lens diaphragm - Close proximity of
iris to cornea in periphery3. Von- Herick Slit-lamp grading of angle
Diagnostic criteria• Gonioscopy – iridotrabecular contact without PAS• IOP – normal• OD – No glaucomatous change• VF – Normal
ANGLE IS AT RISK.
PACPresents in form of:1. Asymptomatic/Quiescent PAC PACG2. Subacute PAC3. Acute PAC
Diagnostic criteria :• Gonioscopy – Irido-trabecular contact• IOP elevated and/or PAS +• OD – normal• VF – normal
ANGLE IS ABNORMAL EITHER IN FUNCTION (IF INC IOP) OR IN STRUCTURE (IF PAS)
SUBACUTE PAC• PPt factors Attack of transient rise in IOP
(45-55 mm HG) – lasts for a few mins to 1-2 hours.
Symptoms• Episode – unilateral transient blurring of vision Coloured halos around light Headache, browache, eyeache on
affected side• Bright light/sleep physiological miosis self
termination of attack• Recurrent attacks – no symptoms b/w attacks
ACUTE PAC• Ppt factors pupillary block sudden closure of
angle attack of rise in IOP does not terminate on it ’s own sight threatening
Symptoms• Sudden severe pain• Nausea, vomiting• Rapidly progressive impairment of vision• Redness• Photophobia• Lacrimation
Signs• Lids – oedematous• Conjunctiva – chemosed,
congested• Cornea – oedematous,
insensitive• AC – shallow• Angle of AC – completely
closed on gonioscopy• Iris – discoloured• Pupil – semidilated,
vertically oval, fixed, non reactive to light/accomodation
• IOP – inc – b/w 40-70 mmHg
• OD – oedematous, hyperaemic
• Fellow eye – Shallow AC, occludable angle
PACG• PAC untreated gradual synechial closure of
angle of AC PACGDiagnostic criteria :• Inc IOP• PAS +• OD – glaucomatous cupping• VFD – similar to POAG• Gonioscopy – iridotrabecular contact
ANGLE IS ABNORMAL IN FUNCTION AND STRUCTURE