terminology and guidelines for glaucoma ii - Kwaliteitskoepel

Systemic Risk factors for primary angle-closure 8,11
• Female
• Family history if primary angle-closure
• Necessity of using sympathomimetics or sympatholytics
• Race: Eskimo, Asians
Primary angle-closure. Descriptions of Glaucoma types 12,13
Primary angle-closure glaucoma is divided into 3 subtypes:
• Acute Angle-Closure Glaucoma (AACG)
• Intermittent Angle-Closure Glaucoma (IACG)
• Chronic Angle-Closure Glaucoma (CACG)
Etiology: iridotrabecular contact and/or adhesion
Pathomechanism: decreased aqueous outflow due to TM occlusion
Features: angle-closed at gonioscopy, without a discernible cause
2.4.1.1 - Acute Angle-Closure Glaucoma (AACG)
Etiology: circumferential iris apposition to the trabecular meshwork with rapid and excessive increase in intraocular
pressure (IOP) that does not resolve spontaneously.
Pathomechanism: see Ch. 2.4.1
Features:
Signs:
IOP elevated often to 50-80 mm Hg
Decreased visual acuity
Corneal edema, initially mostly epithelial edema
Shallow or flat peripheral anterior chamber
Peripheral iris pushed forward and in contact with Schwalbe’s line.
Gonioscopy: angle-closure 360 degrees
Pupil mid-dilated and reduced or no reactivity
Venous congestion and ciliary injection
Fundus: disc edema, with venous congestion and splinter hemorrhages, or the disc may be normal or
show glaucomatous escavation
Bradycardia or arrhythmia
Gonioscopy clues from the other eye
Symptoms:
Blurred vision
“Halos” around lights
Pain
Frontal headache of variable degree on the side of the affected eye
Nausea and vomiting, occasionally
Palpitations, abdominal cramps, occasionally
2.4.1.2 - Intermittent Angle-Closure Glaucoma (IACG)
Etiology: similar but milder clinical manifestations than AACG, it resolves spontaneously.
Pathomechanism: see ch. 2.4.1
Features:
Signs:
May vary according to amount of appositional closure of chamber angle and mimic acute angle-closure in
a mild form. When not on miotics, pupil is round and reactive
Ch. 2 - 15 EGS