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Acute Angle-Closure Glaucoma

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Acute Angle-Closure Glaucoma Symptoms

With acute angle-closure glaucoma, because the rise in pressure is rapid, the symptoms also occur suddenly. Understandably, people who are experiencing acute angle-closure glaucoma are extremely uncomfortable and distressed.

Dramatic symptoms of acute angle-closure glaucoma include the following:

  • 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

In acute attacks of angle-closure glaucoma, it is common for only one eye to be involved and for symptoms to worsen.

Some people may experience intermittent episodes of angle closure and elevated IOP without ever having a full-blown attack of angle-closure glaucoma. This is called subacute angle-closure glaucoma.

People with subacute angle-closure glaucoma may have no symptoms, or they may experience mild pain, have slightly blurred vision, or see haloes around lights. These symptoms resolve spontaneously as the angle reopens.

When to Seek Medical Care

Acute angle-closure glaucoma is a medical emergency and must be promptly treated to prevent optic nerve damage and vision loss.

Eye pain, headache, blurred vision, and nausea may occur if the pressure increases suddenly inside the eye. If you experience any of these symptoms, call your ophthalmologist (a medical doctor who specializes in eye care and surgery) immediately.

Exams and Tests

During an examination for angle-closure glaucoma, your ophthalmologist performs the following tests: gonioscopy, tonometry, biomicroscopy, and ophthalmoscopy. Each test is described below.

  • Gonioscopy is performed to check the drainage angle of your eye; to do so, a special contact lens is placed on the eye. This test is important to determine if the angles are open, narrowed, or closed and to rule out any other conditions that could cause elevated IOP.
  • Tonometry is a method used to measure the pressure inside the eye. Eye pressure is measured in millimeters of mercury (mm Hg). Normal eye pressure ranges from 10-21 mm Hg. In a case of acute angle-closure glaucoma, IOP may be as high as 40-80 mm Hg.
  • Biomicroscopy is a technique to examine the front of your eyes and uses a special microscope called a slit lamp. This examination may reveal a poorly reactive pupil, a shallow anterior chamber, corneal swelling, redness around the iris, and inflammation.
  • Ophthalmoscopy is used to examine the optic nerves for any damage or abnormalities; this may require dilation of the pupils to ensure an adequate examination of the optic nerves. This test may reveal a swollen optic nerve in an acute attack of angle-closure glaucoma. If episodes of angle-closure glaucoma have been chronic (long term), this test may reveal excavation of the optic disk, which is a depression in the front surface of the optic nerve.

If an attack persists or if several milder incidents of angle closure have occurred in the past, your ophthalmologist looks for additional signs of previous attacks.

  • Peripheral anterior synechiae (scarring) and adhesions may be visible between the cornea and the iris. Peripheral anterior synechiae may destroy the trabecular meshwork, and adhesions may cause permanent dilation of the iris.
  • Glaucoma flecks (also known as glaukomflecken) are spots on the lens of the eye. Glaucoma flecks may be seen if an acute attack of angle closure has occurred in the past.
  • Atrophy of the iris provides further evidence of a prior attack if it occurred 3 or more weeks prior to the eye examination. The atrophied part of the iris appears gray.

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