Primary angle closure glaucoma

1. PRIMARY ANGLE
CLOSURE GLAUCOMA

2. Primary angle closure disease
is characterised by apposition
of peripheral Iris against the
trabecular meshwork resulting
in obstruction of aqueous
outflow by closure of an
already narrow angle of the
anterior chamber.

6. --hypermetropic eyes with shallow
anterior chamber
-- eyes with narrow angle of
anterior chamber, which may be
due to small eyeball, relatively
large size of the lens and smaller
diameter of the cornea.

9. Plateau Iris configuration
Angle closure glaucoma without
pupillary block.
The anterior chamber angle is
closed by a pushing mechanism
because of the anterior positioned
ciliary processes displacing the
peripheral Iris anteriorly.

14. SLIT LAMP EXAMINATION
-- decreased anterior chamber
depth
-- close proximity of Iris to
cornea in the periphery

15. VAN HERICK GRADING

26. Clinical features:-
PACG may clinically manifest as
subacute, acute or chronic PACG.
Subacute and acute PACG clinically
present as similar to subacute and acute
PAC , respectively; except that
glaucomatous optic disc changes and
visual field defects are always present in
PACG.

27. Chronic PACG
Intraocular pressure remains
constantly raised.
Eyeball remains white and painless.
Gonioscopy reveals more than 270'
of angle closure along with
peripheral anterior synechiae.

35. MANAGEMENT
-- laser iridotomy alone or along with
medical therapy.
-- Trabeculectomy is needed when
the above treatment fails to control
IOP.
-- Prophylactic laser iridotomy in
fellow eye must also be performed.