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Angle Closure Glaucoma


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Angle Closure Glaucoma

  1. 1. Angle Closure Glaucoma<br />
  2. 2. CLASSIFICATION<br />
  3. 3. DEFINITION<br />Closed-angle glaucomas are characterized by a shallow anterior chamber that forces the root of the mid-dilated iris forward against the trabecular network, obstructing the drainage of aqueous humor and thereby increasing the intraocular pressure.<br />Groups at Risks<br />Age &gt;60 years<br />Gender: females &gt; males (4:1)<br />Race: Asians<br />Family history: increased risk with 1st degree relatives<br />
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  8. 8. PHYSIOLOGICAL PUPILLARY BLOCK<br />1. Iris has large arc of contact with anterior surface of lens<br />2. Resistance to aqueous flow from posterior to anterior chamber (relative pupil block)<br />4. Iris lies against trabecular meshwork  impede aqueous humor drainage  ↑ IOP<br />3. Pupil dilates, peripheral iris becomes more flaccid and pushed anteriorly<br />
  9. 9. SYMPTOMS<br />Rapidly progressive impairment of vision<br />Painful eye<br />Red eye<br />Nausea, vomiting<br />Photophobia<br />Haloes, transient blurring – indicate previous intermittent attacks<br />Hx of similar attacks in the past, aborted by sleep<br />** CACG: usually asymptomatic due to slow onset of disease<br />
  10. 10. SIGNS<br />Reduced visual acuity<br />Cornea cloudy and oedematous<br />Pupil oval, fixed and moderately dilated<br />Ciliaryinjection<br />Eye feels hard on palpation<br />Elevated IOP (50-100 mmHg)<br />Narrow chamber angle with peripheral iridocornealcontact<br />Aqueous flare and cells<br />Gonioscopy– complete peripheral iridocornealcontact<br />Ophthalmoscopy– optic disc odema and hyperaemia<br />
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  12. 12. ACUTE CONGESTIVE ANGLE CLOSURE GLAUCOMA<br />Due to rapid ↑ in IOP<br />Defined as: <br />
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  14. 14. Corneal trauma or infection<br />Acute congestive glaucoma<br />Acute iridocyclitis<br />Acuteconjunctivitis<br />Common<br />Uncommon<br />Common<br />Extremely common<br />Incidence<br />Watery or purulent<br />None<br />None<br />Moderate to copious (mucopurulent)<br />Discharge<br />Usually blurred<br />Markedly blurred<br />Slightly blurred<br />No effect on vision<br />Vision<br />Moderate to severe<br />Severe<br />Moderate<br />variable<br />Pain<br />DIFFERENTIAL DIAGNOSIS<br />
  15. 15. Diffuse<br />Diffuse<br />Mainly circumcorneal<br />Diffuse, more toward fornices<br />Conjunctival injection<br />Change in clarity related to cause<br />Hazy<br />Usually clear<br />Clear<br />Cornea<br />Normal<br />Semidilated and fixed<br />Small<br />Normal <br />Pupil size<br />Normal<br />None<br />Poor<br />Normal<br />Pupillary light response<br />Normal<br />Elevated<br />Normal<br />Normal<br />Intraocular pressure<br />Organisms found only in corneal ulcers due to infection<br />No organisms<br />No organisms<br />Causative organisms<br />Smear <br />
  16. 16. MANAGEMENT<br />Emergency treatment is required – preserve the sight!<br />Prevent adhesions of peripheral iris to trabecular meshwork resulting in permanent closure of angle<br />I.V acetazolamide500mg followed by oral acetazolamide 250mg qid after acute attack has broken<br />Topical beta-blockers<br />Topical steriodsfour times daily to lower the intraocular pressure and decongest the eye<br />
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  18. 18. SURGICAL MANAGEMENT<br />Peripheral laser iridotomy (LPI)<br /> (YAG Laser)<br />To establish the communication between the posterior and anterior chambers by making an opening in the peripheral iris<br />This will be successful only if less than 50% of the angle is closed by permanent peripheral anterior synechiae<br />Peripheral Iridectomy<br />
  19. 19. CX AND SEQUALAE<br />Peripheral anterior synechiae (PAS) – the peripheral iris adheres to the posterior corneal surface in the trabecular area and blocks the outflow of aqueous<br />Cataract- swelling of the lens and cataract formation – this may push the iris even further anteriorly; this increases the pupillary block<br />Atrophy of the retina and optic nerve - glaucomatous cupping of the optic disc and retinal atrophy<br />Absolute glaucoma - eye is stony hard, sightless, painful<br />
  20. 20. SECONDARY ANGLE CLOSURE GLAUCOMA<br />Angle-closure secondary to a variety of ocular disorders<br />Lens abnormalities (thick cataract)<br />Lens dislocation<br />Inflammation (uveitis, scleritis, extensive retinal photocoagulation)<br />Signs and symptoms <br />Same as PACG<br />
  21. 21. THANK YOU<br />