The document discusses the prevalence and risk factors of narrow angles in different populations, noting a general prevalence of 3.8% in the US and significantly higher rates in other groups. Symptoms of acute angle closure include decreased vision, halos, headaches, and eye pain, with signs such as conjunctival congestion and mid-dilated pupils. Treatment options include a combination of medications like pilocarpine, brimonidine, acetazolamide, and timolol, with definitive treatment requiring careful angle estimation.

1. Narrow Angles
Mark G. Mitchell, OD, MBA

2. Prevalence of Narrow Angles
General US population: 3.8%
China: 36%
Inuit: 17%
FHCN: 50-75%

3. Risk Factors
• Family history for angle closure
• Age over
• Women
• Farsighted or small eye
• Racial group: far eastern, Inuit

4. So what?
 High pressure damages optic nerve
 Can progress to blindness quickly

6. Angle Closure Mechanism

8. Symptoms of Acute Angle Closure
• Decreased vision
• Halos around lights/photophobia
• Frontal headache
• Eye pain
• Periocular and/or supraocular
• Nausea and vomiting

9. Angle Closure Signs
• Conjunctival congestion
• Corneal edema=reduced vision
• Mid dilated (vertical oval) pupil
• Absent /sluggish pupil reaction
• Fellow eye shows a narrow angle
• Rapid Onset (30-60min)

11. First Line Treatment
• The Kitchen Sink
• Pilocarpine 2% 1 drop (cholinergic)
• Brimonidine 0.2% 1 drop (alpha adrenergic)
• Acetazolamide 500mg (carbonic anhydrase inhibitor)
• Timolol 0.5% 1 drop (beta blocker)
• And then you wait…

12. Definitive Treatment

13. Definitive Treatment

14. How do you tell???

15. Penlight Angle Estimation

16. Medications Increase Risk
Anticholinergic
Idiosyncratic reactions
Botox

17. eCW ICD-10
H40.033 Anatomically narrow angle, bilateral