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ANGLE CLOSURE
GLAUCOMA
-Anira Iqbal
Batch 2011
CLASSIFICATION
Angle-closure
Glaucoma
Primary Secondary
Acute (AACG)
Chronic (CACG)
TERMINOLOGIES
Primary Angle
Closure Disease :
Narrow angle of AC 
Apposition of
peripheral iris against
TM  Obstruction ...
RISK FACTORS
Demographic Anatomic
Age – 60 to 70 y/o
Gender – M:F 1:3
Heredity – Anatomic RF
Race – SE Asians, Chinese,
Es...
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 r...
Mechanism :
Mydriasis  mild dilatation of pupil  Inc apposition
b/w iris and lens  Relative Pupillary Block (RPB)
Aq. ...
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
...
CLASSIFICATION
Clinical (Based on symptoms)
• Latent primary ACG
• Subacute/Intermittent PACG
• Acute PACG
• Chronic PACG
...
PACS
• Symptoms – Absent
• Presenting situations – Glaucoma Screening
Programme
Routine ocular
exam
Fellow eye in pt of
ac...
2. Slit lamp biomicroscopy – Dec axial AC depth
- Convex shaped iris-
lens diaphragm
- Close proximity of
iris to cornea i...
Diagnostic criteria
• Gonioscopy – iridotrabecular contact without PAS
• IOP – normal
• OD – No glaucomatous change
• VF –...
PACPresents in form of:
1. Asymptomatic/Quiescent PAC  PACG
2. Subacute PAC
3. Acute PAC
Diagnostic criteria:
• Gonioscop...
SUBACUTE PAC
• PPt factors  Attack of transient rise in IOP
(45-55 mm HG) – lasts for a few mins to 1-2
hours.
Symptoms
•...
ACUTE PAC
• Ppt factors  pupillary block  sudden closure of
angle  attack of rise in IOP  does not
terminate on it’s o...
Signs
• Lids – oedematous
• Conjunctiva – chemosed,
congested
• Cornea – oedematous,
insensitive
• AC – shallow
• Angle of...
PACG• PAC  untreated  gradual synechial closure of
angle of AC  PACG
Diagnostic criteria:
• Inc IOP
• PAS +
• OD – glau...
Angle closure glaucoma
Angle closure glaucoma
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Angle closure glaucoma

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Angle closure glaucoma

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Angle closure glaucoma

  1. 1. ANGLE CLOSURE GLAUCOMA -Anira Iqbal Batch 2011
  2. 2. CLASSIFICATION Angle-closure Glaucoma Primary Secondary Acute (AACG) Chronic (CACG)
  3. 3. TERMINOLOGIES Primary 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
  4. 4. 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 diaphragm placed anteriorly Plateau Iris config. Narrow angle of AC Small eyeball Large lens Smaller D of cornea Bigger size of CB Anterior insertion of iris on CB
  5. 5. PATHOGENESIS Pupillary block mechanism (70%) Phacomorphic mechanism (20%) Plateau Iris configuration (10%)
  6. 6. 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 • Vasoconstrictors 3 Pharmacological miosis – Echothiophate, Pilocarpine
  7. 7. 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
  8. 8. Miosis  contract ciliary muscles  Zonules relax  lens moves forward  contact of iris with lens
  9. 9. 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
  10. 10. CLASSIFICATION Clinical (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) -
  11. 11. PACS • Symptoms – Absent • Presenting situations – Glaucoma Screening Programme Routine ocular exam Fellow eye in pt of acute PAC • Signs: 1. Eclipse sign
  12. 12. 2. Slit lamp biomicroscopy – Dec axial AC depth - Convex shaped iris- lens diaphragm - Close proximity of iris to cornea in periphery 3. Von- Herick Slit-lamp grading of angle
  13. 13. Diagnostic criteria • Gonioscopy – iridotrabecular contact without PAS • IOP – normal • OD – No glaucomatous change • VF – Normal ANGLE IS AT RISK.
  14. 14. PACPresents in form of: 1. Asymptomatic/Quiescent PAC  PACG 2. Subacute PAC 3. 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)
  15. 15. 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
  16. 16. 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
  17. 17. 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
  18. 18. PACG• PAC  untreated  gradual synechial closure of angle of AC  PACG Diagnostic criteria: • Inc IOP • PAS + • OD – glaucomatous cupping • VFD – similar to POAG • Gonioscopy – iridotrabecular contact ANGLE IS ABNORMAL IN FUNCTION AND STRUCTURE

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