Acute angle-closure glaucoma is a serious eye disease that can cause permanent vision damage or blindness if not treated immediately. It occurs when the angle between the iris and the trabecular meshwork is narrowed, leading to blockage in the canals. Symptoms include eye pain, headache, and blurred vision. Treatment involves reducing intraocular pressure and surgery to promote better drainage.
Acute angle-closure glaucoma is a potentially serious eye disease in which fluid and pressure build up to dangerous levels in the eye. A person may experience sudden, severe pain in and behind the eyes, blurred vision, and nausea. The disorder can lead to permanent vision damage or even blindness if not addressed and treated immediately. The drugs are given orally and through eye drops to reduce intraocular pressure (IOP) and relieve acute pain. Most patients require surgery following emergency medical care to promote better drainage and prevent a recurrent attack of acute angle-closure glaucoma.
A lubricating fluid called the aqueous humor normally drains from the back of the eye through a series of channels collectively called the trabecular meshwork. Acute angle-closure glaucoma occurs when the angle between the iris and the trabecular meshwork is significantly narrowed, leading to blockage in the canals. IOP develops because the aqueous humor has nowhere to go; it continues to be produced and accumulates behind the lens of the eye.
Acute angle-closure glaucoma is more likely to affect farsighted people and the elderly. Farsightedness is characterized by narrow angles between the iris and the ciliary body, the structure that produces the aqueous humor. A narrower angle is more susceptible to closure from slight movements of the iris. As people age, the lenses of their eyes naturally widen and the angles narrow. Also, acute angle-closure glaucoma is more common in women than men. Subtle birth defects in the lens, iris, trabecular meshwork, or optic nerve can also increase a person’s chances of developing problems.
In most cases, symptoms of eye pain, headache, and blurred vision develop within hours of the onset of acute narrow-angle glaucoma. A person may become dizzy, nauseous, and very sensitive to light and motion. The affected eye may turn red, look swollen, and produce excess tears. It is important to seek emergency care at the first signs of acute angle-closure glaucoma to prevent serious complications.
In the emergency room, a doctor can confirm the presence of IOP by inspecting the eye and asking about symptoms. A special test called gonioscopy can be used to confirm that the drainage angles are indeed closed. During gonioscopy, your doctor inserts a magnifying contact lens into your eye and inspects the trabecular meshwork with a specialized type of microscope called a slit lamp. Treatment decisions are made immediately after diagnostic tests.
Most patients are given eye drops, oral medications, intravenous medications, or a combination of the three to relieve IOP quickly. Corticosteroids and other medications can help relieve eye inflammation and slow the production of aqueous humor. Once the IOP is normalized, an optometrist can schedule a surgical procedure called a laser peripheral iridotomy, usually to be done within two days. A laser is used to burn a new pathway for aqueous humor to drain through the iris. Iridotomy is usually done on both eyes, even when only one eye is affected, to reduce the chances of another episode.
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