Acute Closed Angle Glaucoma: Pathogenesis and Clinical Findings

OPHTHALMIC EMERGENCY: Early detection is essential, but most patients who present with early glaucoma are asymptomatic.

 • The disease must be ruled out in patients who present with a red eye and are acutely ill

 • Colored halos around bright lights are a key symptom of prodromal episodes

Epidemiology

 • Significant cause of blindness in North America and the most frequent cause of blindness among African Americans

 • Incidence increases in patients of advancing age and in patients with a family history

 • Occurs in small eyes (often hypermetropic), which thus have shallow anterior chambers



Anatomic abnormalities (i.e thinner ciliary bodies, shallow ACD, small axial length) -> crowding of ocular structures

-> Increased resistance to the flow of aqueous humour from the posterior to anterior chamber

-> Increased pressure gradient bows iris forward

-> Iridocorneal angle closure

-> Prolonged Increased IOP leads to optic nerve damage & blindness

Signs / Symptoms / Complications:

 • Consolidation of obstruction

 • Corneal edema & clouding

 • Visual field defects (scotomas of various shapes, generally with central sparring)

 • Loss of vision

 • Photophobia



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