Angle closure glaucoma (ACG) is characterized by obstruction of aqueous humor drainage due to the closure of the angle between the iris and cornea, leading to increased intraocular pressure. It primarily affects individuals over 60 years, with a higher prevalence in females and Asians, and can be classified into acute, chronic, and secondary forms. Management includes systemic treatments, topical therapies, and surgical interventions to preserve vision.

1. Angle Closure
Glaucoma
ABUBAKAR AMEER
ROLL NO. 140

2. LEARNING OBJECTIVES
Define Angle Closure Glaucoma (ACG)
Signs of ACG
Symptoms of ACG
Treatment of ACG

3. DEFINITION
• Closed-angle glaucoma are characterized by closure of
angle between iris and cornea at the periphery,
obstructing the drainage of aqueous humor and
thereby increasing the intraocular pressure.
Groups at Risks
1. Age >60 years
2. Gender: females > males (4:1)
3. Race: Asians
4. Family history: increased risk with 1st
degree relatives

5. CLASSIFICATION
Angle-Closure
Glaucoma
Primary
Acute (AACG) Chronic (CACG)
Secondary
Lens abnormalities
(thick cataract)
Lens dislocation

6. PREDISPOSING FACTORS
• Relative anterior position of iris-lens
diaphragm
• Shallow anterior chamber
• Narrow entrance to angle
Anatomical
• Physiological pupillary block
Physiological

7. PHYSIOLOGICAL PUPILLARY BLOCK
1. Iris has large arc of
contact with anterior
surface of lens
2. Resistance to
aqueous flow from
posterior to anterior
chamber (relative
pupil block)
3. Pupil dilates,
peripheral iris
becomes more
flaccid and pushed
anteriorly
4. Iris lies against
trabecular
meshwork 
impede aqueous
humor drainage 
↑ IOP

8. SYMPTOMS
1. Rapidly progressive impairment of
vision
2. Painful eye
3. Red eye
4. Nausea, vomiting
5. Photophobia
6. Haloes, transient blurring – indicate previous
intermittent attacks
7. Hx of similar attacks in the past
** CACG: usually asymptomatic due to slow onset of
disease

9. SIGNS
1. Reduced visual acuity
2. Cornea cloudy and oedematous
3. Pupil oval, fixed and moderately dilated
4. Ciliary injection
5. Eye feels hard on palpation
6. Elevated IOP (50-100 mmHg)
7. Narrow chamber angle with peripheral
iridocorneal contact
8. Gonioscopy – complete peripheral
iridocorneal contact

10. Severe
edematous
cornea.
Dilated,
unreactive,
vertically oval
pupil
Shallow
anterior
chamber
Complete
angle closure

11. MANAGEMENT
1. Acetazolamide 500mg IV followed by 250mg
orally after every 6 hours
Emergency treatment is
required – preserve the sight!
SYSTEMIC THERAPY
2.Mannitol 2.5 to 10ml of 20% solution per Kg of
body weight orally
3. Analgesics for relief of pain
4. Antiemetics for control of vomiting

12. MANAGEMENT
TOPICAL THERAPY
1. Pilocarpine 2% four times a day
2. Beta blockers ( Timolol 0.5% twice a day)
3. Corticosteroids can be used to treat inflammation
of anterior segment

13. SURGICAL MANAGEMENT
1. Peripheral laser iridotomy
– To establish the communication between the posterior
and anterior chambers by making an opening in the
peripheral iris
– This will be successful only if less than 50% of the
angle is closed
2. Peripheral Iridectomy

14. SECONDARY ANGLE CLOSURE GLAUCOMA
• Angle-closure secondary to a variety of
ocular disorders
– Lens abnormalities (thick cataract)
– Lens dislocation
– Inflammation (uveitis, scleritis, extensive retinal
photocoagulation)
• Signs and symptoms
– Same as PACG

15. TAKE HOME MESSAGE…

16. THANK YOU!
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