![]() Secondary angle closure is caused by an underlying identifiable pathologic etiology, such as neovascularization or uveitis (see “Differential Diagnosis” section). Primary angle closure glaucoma (PACG)-iridotrabecular contact is present in three or more quadrants of the drainage angle in the presence of documented optic nerve damage and visual field loss. The eye does not have glaucomatous damage of the optic nerve. Primary angle closure (PAC) – An eye that has a primary anatomic narrow angle and evidence that trabecular obstruction by the peripheral iris has occurred, such as peripheral anterior synechiae (PAS), elevated IOP, iris whorling or sectoral atrophy, and excessive pigment deposition on the trabecular surface. IOP, optic nerve, and visual field are normal. The peripheral iris is located close to, but not touching, the posterior pigmented trabecular meshwork (TM). ![]() Primary angle-closure suspect (PACS) or anatomic narrow angle – An eye in which the anterior chamber angle recess has an abnormally narrow angular width. In primary angle closure, the mechanism causing disease is primarily pupillary block, being either functional or absolute, while in secondary forms there are other underlying causes. There are primary and secondary forms of angle closure glaucoma. This review will discuss risk factors, signs and symptoms, diagnostic tests and imaging modalities, pathophysiology, differential diagnosis, and treatment modalities of angle closure glaucoma.Īngle closure glaucoma (ACG) results from appositional or synechial closure of the anterior chamber angle leading to reduction in aqueous outflow facility, IOP elevation, and subsequent damage to the optic nerve with associated visual field loss. Although angle closure in all its forms is vision threatening, early diagnosis and appropriate management can stabilize disease and minimize vision loss. The mainstays of therapy are medications that lower intraocular pressure and laser peripheral iridotomy for any component of pupillary block. ![]() This distinction is crucial as the treatment of each form can vary greatly. A thorough history and eye examination are essential in differentiating between primary and secondary forms. Both types of angle closure glaucomas may cause acute dramatic attacks or chronic asymptomatic disease. In primary angle closure glaucoma, the underlying mechanism is primarily pupillary block, while in secondary forms there are other underlying causes that either push the iris forward from behind or pull the iris forward to contact trabecular meshwork. In angle closure glaucoma, increased intraocular pressure is caused by impaired outflow facility secondary to appositional or synechial closure of the anterior chamber drainage angle. This disease has a familial tendency and is associated with increasing age and hyperopia.
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