Acute Closed-Angle Glaucoma-an Ophthalmological Emergency

Abstract

Background: Acute closed-angle glaucoma has an incidence of 2.2-4.1 cases per 100 000 persons per year in Europe. It is an ophthalmological emergency in which markedly elevated intraocular pressure can damage vision permanently. Because the acute symptoms are not always clearly referable to the eyes, patients often present to physicians who are not ophthalmologists.

Methods: This review is based on pertinent articles retrieved by a selective search in PubMed.

Results: The diverse symptoms of acute closed-angle glaucoma include eye redness, worsening of vision and other visual disturbances, headache, and nausea. Acute closed-angle glaucoma has multiple causes. Not all predisposing factors have been definitively identified; above all, there are certain anatomical configurations of the eye that make it more likely to arise. The goals of treatment are to reduce the elevated intraocular pressure rapidly, which usually leads to marked symptom relief, as well as to eliminate the situation that led to closed-angle glaucoma. For proper treatment, the patient should be seen by an ophthalmologist without delay, on the day of symptom onset if possible.

Conclusion: Primary prevention of acute closed-angle glaucoma is not always possible. Even physicians who are not ophthalmologists can diagnose markedly elevated intraocular pressure by palpation of the globe. Proper, specific treatment can help patients rapidly and lastingly.

Figure 1

Mechanism of primary angle closure by pupillary block: a) The physiological flow of aqueous fluid from the ciliary body into the trabecular meshwork. b) Pupillary block forces accumulation of the aqueous fluid behind the iris, pressing it forward. The trabecular meshwork becomes obstructed, resulting in angle closure

Figure 2a–c

The correct procedure for palpation of the eyeball Downward gaze with eyes open (a). Fingers of both hands resting on temple and forehead, index fingers on eyelid, alternating gentle pressure (b). Palpation of other eye—also by less experienced examiners, for comparison (c).

Figure 3

Clinical findings on slit-lamp examination: a) In acute angle closure: clear reddening with ciliary injection (*); pupil moderately widened and no longer exactly circular (distorted area shown by +++); clouding of iris structures by corneal edema (#) b) In a normal eye: no irritation of conjunctiva (*); pupil round, constricted on illumination (+++); clearly discernible iris structures (#)