This document discusses different types of angle closure conditions including primary angle closure suspect (PACS), primary angle closure (PAC), and primary angle closure glaucoma (PACG). It provides details on diagnosis, risk factors, symptoms, examination findings, treatment options including laser iridotomy, and management of acute angle closure attacks.

1. Primary Angle Closure
Suspect (PACS)
Primary Angle
Closure (PAC)
Primary Angle Closure
Glaucoma (PACG)
Number of
closed angle
quadrants
3 or more 3 or more 3 or more
Peripheral
Anterior
Synechia (PAS)
No Yes Yes
IOP Normal Raised Raised
ONH Normal Normal
Glaucomatous
neuropathy
Visual field Normal Normal Affected
• The term ‘angle closure’ refers to occlusion of the trabecular meshwork by the
peripheral iris (irido-trabecular contact – ITC), obstructing aqueous outflow.

2. Failure of physiological aqueous
flow through the pupil leads to a
pressure differential between the
anterior and posterior chambers,
with resultant anterior bowing of the
iris.
A thicker, anteriorly positioned iris
root

3. • More common in old age
• More common in Asian individuals
• More common in Hyperopic individuals with
short axial length
• More common in females

4. • Nothing in the majority of cases
• Presentation can be with intermittent mild symptoms of
blurring (‘smoke-filled room’) and haloes (‘rainbow around
lights’) due to corneal epithelial oedema.
• or acutely with markedly decreased vision, redness and
ocular/periocular pain and headache; abdominal pain and
other GIT symptoms may occur (Vagal stimulation).

5. • Watching TV in darkened room
• Pharmacological mydriasis
• Acute emotional stress

6. • May be only intermittent elevation
• ONH signs depend on severity of
damage
• Not affected except in advanced cases
• Not affected except in advanced cases (RAPD in post glaucomatous
OA)
• Narrow or closed angle
• To exclude causes of 2ry glaucoma
• Shallow (Pupil block) or deep (Plateau iris)

7. • very high 50 - 100 mmHg
• Epithelial edema
• 6/60 to HM
• Mid dilated , fixed
• Narrow or closed angle (might be
difficult due to corneal edema)
• To exclude causes of 2ry glaucoma
• Ciliary injection
• Shallow (Pupil block) or deep (Plateau iris)

8. • The patient sits in a dark room, face
down for one hour without sleeping
(sleep induces miosis).
• The IOP is checked (immediately after
the test, as IOP can normalise very
rapidly)
• An IOP rise of 8 mmHg or more is
frequently taken as being of
significance.

9. • To assess AC angle
• To assess AC angle
• After the acute attack resolves

10. • Phacomorphic glaucoma
• NVG
• PXG
• PG
• Inflammatory glaucoma
• Malignant glaucoma
• Keratitis
• Conjunctivitis
• Iritis
• Scleritis

11. Causes of Red Eye
Conjunctivitis Keratitis Iritis
Acute Congestive
Glaucoma
Pain Discomfort Stitching Dull ache Bursting
Discharge Mucopurulent / Purulent Lacrimation Lacrimation Lacrimation
Vision slight blurred Marked diminution Moderately affected Marked diminution
IOP Normal Normal or high Normal, high or low Very high
Pupil Normal +/- miosis Miosis Mid dilated, fixed
Conjunctiva Conjunctival injection Ciliary injection Ciliary injection Ciliary injection
Cornea Normal Ulcer KPs Edema
AC Normal
Activity
Hypopyon
Activity
Hypopyon
Shallow
Iris Normal Muddy Muddy Congested

12. Laser iridotomy (YAG)
Laser iridoplasty (Argon)

13. • Systemic: Oral Acetazolamide, IV Mannitol
• Topical:
Pilocarpine (Parasympathomimetic)
Timolol
Prednisolone
• Hospital Admission
• Systemic analgesics, anti emetics

14. • Perform Gonioscopy
• Peripheral laser iridotomy
• Central corneal indentation with squint hook or goniolens
• Early laser iridotomy after clearing corneal oedema with topical
glycerol
• Paracentesis
• Surgery:
Peripheral iridectomy (Appositional angle closure)
Lens extraction (Appositional angle closure)
SST (Synechial angle closure)
Cyclodiode (Absolute Glaucoma)