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Acute Angle-Closure Glaucoma

Acute Angle-Closure Glaucoma Treatment

Self-Care at Home

No self-care is effective. Immediate treatment by an ophthalmologist is necessary to try to prevent further permanent vision loss.

 

Medical Treatment

An ophthalmologist must treat angle-closure glaucoma with either laser therapy or surgical therapy (see Surgery).

  • A laser iridotomy is the most commonly performed procedure. During a laser iridotomy, your eye doctor uses a laser beam to make a hole in the iris to reduce the pressure inside the eye. By making a hole in the iris, the fluid (aqueous humor) is better able to drain out from the posterior chamber to the anterior chamber of the eye.
  • If the iris cannot be accessed with a laser beam for some reason, a surgical (or incisional) iridectomy is performed, wherein your eye doctor creates the hole in the iris by making surgical incisions.

Prior to a laser iridotomy, your ophthalmologist uses medicines to reduce the pressure inside the eye and to clear up the cloudiness of the cornea that occur during an acute attack of angle-closure glaucoma. Also, because the pupil is often partially dilated (or enlarged), it is constricted (or made smaller) before laser surgery. See Medications.

 

Medications

Medicines that are used for acute angle-closure glaucoma prepare you to undergo either a laser iridotomy or a surgical iridotomy. They come in the form of medicated eyedrops (see How to Instill Your Eyedrops).

Prior to surgery, your ophthalmologist uses medicines to reduce the pressure inside the eye and to clear up the cloudiness of the cornea that occur during an acute attack of angle-closure glaucoma.

In acute angle-closure glaucoma, several drugs are used simultaneously to accelerate and maximize their pressure-lowering effects. The drugs lower IOP by decreasing the production of fluid in the eye.

Surgery

Laser iridotomy

Laser iridotomy is the treatment of choice for angle-closure glaucoma. Iridotomy is performed using either an argon laser or an Nd:YAG laser.

The laser beam creates an opening in the iris through which the fluid (aqueous humor), which is trapped in the posterior chamber, can reach the anterior chamber and the trabecular meshwork (or drainage channels). As the fluid flows into the anterior chamber through this opening in the iris, the pressure behind the iris (ie, inside the eye) falls, allowing the iris to return to its normal position. This procedure opens the angle of the anterior chamber and relieves the blockage at the trabecular meshwork.

If the cornea is extremely cloudy or if the person cannot cooperate, a surgical (or incisional) iridectomy may be performed instead of a laser procedure. With a surgical iridectomy, the ophthalmologist creates the hole in the iris by making surgical incisions.

Laser gonioplasty

Laser gonioplasty is sometimes used as a treatment of angle-closure glaucoma or as a temporary measure to open the angle until a laser iridotomy can be performed.

During a laser gonioplasty, a laser beam is used to create burns in the iris. These burns cause the iris to contract and flatten, which, in turn, causes the angle of the anterior chamber to deepen (ie, opens the angle).

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