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James B. Wanner, OD
Acute Angle Closure Glaucoma
Maryland Eye Associates
. http://marylandeyeassociates.com

Acute Angle Closure Glaucoma

Some types of glaucoma can cause eye pain. Acute angle closure glaucoma can cause severe eye pain, headache, blurred vision, nausea, and vomiting. All of these symptoms occur from the eye pressure going up to levels often 2-3 times normal. The optic nerve can be permanently damaged by this rise in pressure. This damage is a type of optic neuropathy called glaucoma.

There are many types of angle closure glaucoma. They include acute angle closure, intermittent angle closure, and chronic angle closure.

Acute angle closure glaucoma typically causes severe pain and the other symptoms above due to a rapid rise in the eye pressure. Intermittent angle closure glaucoma can have some or all of the above symptoms but as the name implies these symptoms come and go. Chronic angle closure glaucoma often has no symptoms or they may be mild (this is similar to the open angle types of glaucoma).

Acute angle closure glaucoma is typically a very painful disease. The eye pressure shoots up very quickly and leads to swelling of the cornea (front clear part of the eye). The eye pain is often interpreted by the patient as a headache. It can be hard for the patient to localize the pain to the eye. Severe nausea and vomiting often accompanies this acute rise in eye pressure as well. Patients may not be aware of their blurred vision due to the severe headache, nausea and vomiting that they have. Because of the systemic symptoms the patients feel, they usually go to their primary doctor or the emergency room complaining of headache, nausea and vomiting. This can be a difficult diagnosis to make based on the presenting symptoms.

Once diagnosed, an ophthalmologist will administer glaucoma medications to try and “break” the acute attack. If this cannot be done with medications then an emergent “peripheral iridotomy” may need to be placed depending on the cause of the attack. An iridotomy is a hole placed in the iris (colored part of the eye) with laser or in the operating room. This hole in the iris allows fluid to flow directly from the posterior chamber of the eye to the anterior chamber of the eye without having to travel through the pupil. This will allow the iris to move out of the angle of the eye where the natural drainage system of the eye is located. Permanent scarring of the iris to the angle may occur in certain areas and can lead to chronic angle closure glaucoma.

When the acute attack has been broken either with medications and or an iridotomy the symptoms improve. If the attack is broken with medications then an iridotomy is often performed soon after to try and prevent future attacks, again depending on the underlying cause.

Patients may need to be treated with glaucoma medications for the rest of their lives, depending on damage that may have occurred to the optic nerve and scarring.

Acute angle closure glaucoma is most commonly caused by “pupillary block.” In pupillary block, the fluid made in the posterior chamber of the eye that then comes to the front of the eye through the pupil, cannot get through. This is because the iris is tight up against the lens of the eye, not allowing fluid into the anterior chamber.

When this happens the iris bows forward and the drainage system, in the angle, is clogged with iris tissue. The eye continues to make fluid but it cannot drain it. The eye typically replaces all of the fluid in the eye in less then two hours so without a way to drain fluid the pressure can spike quickly. There are other causes of acute angle closure glaucoma then pupillary block and they include uveitis, neovascularization, and medications to name a few.

If you have acute or intermittent blurred vision with eye pain/headache, nausea and or vomiting you should be evaluated by an ophthalmologist for evaluation and treatment.

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