Acute angle-closure glaucoma is an ocular emergency
that potentially leads to irreversible blindness
if the treatment is delayed. The main etiology is the
iridotrabecular contact, resulting in anterior chamber
angle closure and inadequate drainage of aqueous
humor hence the intraocular pressure (IOP) suddenly
increases. Risk of angle closure is high among the
elderly, women, Asian population and those with
hyperopia. Diagnosis relies on history of symptoms
resulting from the acute IOP rising and ocular examination
demonstrating angle closure with anatomical
risk factors. Patients usually present with acute severe
painful blurred vision, ciliary injection, seeing rainbow
halo around lights, nausea, vomiting and headache.
Ocular examination shows high IOP, shallow anterior
chamber, anterior lens position, closed anterior
chamber angle, and occasionally, optic disc edema.
Treatment consists of immediate IOP reduction,
control of inflammation and reopen the angle by
laser or lens extraction with goniosynechialysis.
Serial gonioscopy is considered for the long-term
angle monitoring. Trabeculectomy is performed in
cases of uncontrolled IOP after reopening of the
angle.