This document provides information about angle closure glaucoma from Amity Medical School. It defines glaucoma and discusses the anatomy of the anterior chamber and drainage angle. It describes the differences between open-angle glaucoma and angle closure glaucoma, including causes and risk factors. Treatment options are outlined, including medical management with eye drops and surgical options like laser trabeculoplasty and laser iridotomy.

1. Amity Medical School
Angle Closure
Glaucoma
1
Jitender Rathi
B.Optometry (1st Semester)
Amity Medical School ( Optometry & Vision Sciences)

2. Amity Medical School
• Anatomy
• Aqueous Physiology and IOP
• Definition of Glaucoma
• Classification
• Etiology
• Treatment
• Medical Management
• Surgical Management
2
Outlines

3. Amity Medical SchoolANATOMY
3

4. Amity Medical School
Anatomy of the drainage angle
The anterior chamber(AC)
• is that space, containing aqueous humor, which is bounded
in front by the cornea and part of the sclera, and behind by
the iris and part of the ciliary body.
• Its normal depth in adults varies from 2.5-3.5mm.
The angle of the anterior chamber.(iridocorneal angles)
• Between the iris and the cornea at the periphery of the
anterior chamber of the eye.
• Refers to that peripheral recess bounded posteriorly by the
root of the iris and the ciliary body and anteriorly by the
corneo-scleral junction or the limbus.
• There is an annular channel, called the canal of Schlemm.
• The canal is separated from the aqueous in the anterior
chamber by the trabecular meshwork. 4

5. Amity Medical School
Aqueous Physiology and IOP
• Fluid circulation within the eye.(Aqueous humor)
• This creates the relatively constant and healthy
pressure within the eye.(IOP)
• Pressure is needed the eye Inflated, Nourished
and helps in functioning properly.
• Rate:2.0 µl/min (Micro Liter Per Minute)
• Over production or inadequate drainage leads to
elevate of IOP.
5

6. Amity Medical School
Route of Aqueous Flow
6

7. Amity Medical School
7

8. Amity Medical School
The trabecular meshwork is made up of
circumferentially disposed flattened collagenous
bands which criss-cross, leaving numerous tortuous
passages through which the aqueous humor drains
from the anterior chamber to the canal of Schlemm.
The aqueous humor is a transparent colorless fluid
which fills the anterior and posterior chambers of the
eye. Its chief site of formation is the processes of
the ciliary body. The volume of aqueous in the
anterior chamber of the human eye is 0.25 ml.
8

9. Amity Medical School
Glaucoma Introduction
A common eye condition in which the fluid pressure inside the eye
rises to a level higher than healthy for that eye. If untreated, it may
damage the optic nerve, causing the loss of vision or even
blindness.
Glaucoma describes a number of ocular conditions characterized
by: -
1-Raised intraocular pressure (IOP).
2-Optic nerve head damage(cupping).
3-Corresponding loss of visual field (VF).
• IOP depends on the relationship between aqueous production
and outflow.
• The normal ocular tension is between 10-21mm.Hg.(Millimeters
of mercury).
• > 22mm Hg is considered abnormal.
• Glaucoma remains one of the principal causes of blindness
throughout the world. 9

10. Amity Medical School
• It is a silent thief.
• Scary part about this disease for both
Doctor and patient is that It is a very silent
disease of the eye, it is so silent that does
not announce itself .
• Patient must get it diagnosed as early as
possible ,before it can drop vision.
10

11. Amity Medical School
Currently, the World Health Organization ranks
glaucoma as the second largest cause of blindness
worldwide, behind cataract
11

12. Amity Medical School
Classification of glaucoma.
There are several types of glaucoma, however, the
two most common are :-
1. open angle glaucoma (OAG), having a slow and
insidious onset.
2. And angle closure glaucoma (ACG), which is less
common and tends to be more acute.
12

13. Amity Medical School
Open angle glaucoma
(OAG).
13

14. Amity Medical School
Open-angle glaucoma, the most common form of glaucoma,
accounting for at least 90% of all glaucoma cases:
• Is caused by the slow clogging of the drainage canals, resulting
in increased eye pressure.
• Has a wide and open angle between the iris and cornea.
• Develops slowly and is a lifelong condition.
• Has symptoms and damage that are not noticed.
“Open-angle” means that the angle where the iris meets the
cornea is as wide and open as it should be. Open-angle glaucoma
is also called primary or chronic glaucoma.
14
OAG

15. Amity Medical School
15

16. Amity Medical School
Angle closure glaucoma
(ACG)
16

17. Amity Medical School
Angle-closure glaucoma, a less common form of
glaucoma:
-Is caused by blocked drainage canals, resulting in a
sudden rise in intraocular pressure.
-Has a closed or narrow angle between the iris and
cornea.
-Develops very quickly.
-Has symptoms and damage that are usually very
noticeable.
-Demands immediate medical attention.
“It is also called acute glaucoma or narrow-angle
glaucoma. Unlike open-angle glaucoma, angle-closure
glaucoma is a result of the angle between the iris and
cornea closing”
Angle Closure glaucoma
17

18. Amity Medical School
Causes of Narrow-Angle Glaucoma
• Pupillary block: if the back of the iris adheres to the lens inside the
eye, the pupillary channel becomes blocked. Then fluid backs up
behind the iris, pushing the iris forward until it closes the drainage
angle in the anterior chamber.
• Iris plateau. In this condition, the iris is attached to the ciliary body
too close to the trabecular meshwork, where drainage occurs. When
the pupil dilates, the peripheral iris tissue bunches up in the
drainage angle and can cover up the trabecular meshwork, causing
IOP to rise quickly.
• Hyperopia. People who are farsighted are more likely to have eyes
with shallow anterior chambers and narrow angles, increasing their
risk for angle-closure glaucoma from pupil dilation or aging changes
in the eye.
• Tumors and other causes. A tumor behind the iris, swelling
associated with inflammation of the ciliary body
(intermediate uveitis) and alteration of the shape of the eye after
surgery for a detached retina also can cause angle-closure
glaucoma. 18

19. Amity Medical School
Risk factors for acute angle-closure glaucoma
• Age. Being over age 60, the lens inside our eyes gets
larger, increasing the risk for pupil block. Also, the
anterior chamber tends to become increasingly shallow,
and the drainage angle may narrow as we age.
• Having a family history of the condition
• Having certain medical conditions, such as diabetes,
heart disease, high blood pressure.
• Having certain eye conditions, such as smaller eyes Far-
sightedness ( Hypropia).
• Females-their eye ball is bit smaller as compare male.
• Taking corticosteroid medications, especially eyedrops,
for a long time.
19

20. Amity Medical School
Angle closure in the plateau iris syndrome
20

21. Amity Medical SchoolSymptoms
• Severe eye pain
• Nausea and vomiting
• Headache
• Blurred vision and/or seeing haloes
around lights (Haloes and blurred vision
occur because the cornea is swollen.)
• Profuse tearing
21

22. Amity Medical School
Management Aims
The aim of management is to
lower IOP sufficiently to arrest
progressive VF loss.
1/Medical treatment:Usually eye
dropes.
2/Surgical treatment:
For Open angle glaucoma
(OAG) Trabeculoplasty provides
a definitive reduction of IOP to
within safe limits in the majority
of cases. 22

23. Amity Medical School
Laser Trabeculoplasty
23

24. Amity Medical School
For Narrow Angle Glaucoma ;Leaser Iridology Is used
24

25. Amity Medical SchoolReferences .
• 1-Book Clinical
Ophthalmology
(Glaucoma)
Wills eye Institute
Douglas J.Rhee
• 2-Lacture Notes from
Dr Najeeb -Youtube
• Various discussions
videos on Glaucoma
25