- Jennifer S Weizer, MD
Jennifer S Weizer, MD
- Assistant Professor of Ophthalmology and Visual Sciences
- University of Michigan Kellogg Eye Center
Glaucoma is a group of eye diseases traditionally characterized by elevated intraocular pressure (IOP). However, glaucoma is more accurately defined as an optic neuropathy and may not always be associated with elevated IOP. Angle-closure glaucoma is characterized by narrowing or closure of the anterior chamber angle.
This topic will discuss types of angle-closure glaucoma, diagnosis and treatment. A discussion of open angle glaucoma is presented separately. (See "Open-angle glaucoma: Epidemiology, clinical presentation, and diagnosis".)
Glaucoma is defined as an optic neuropathy involving a characteristic atrophy of the optic nerve head, often accompanied with typical visual field defects . Examination of a glaucomatous optic nerve reveals "cupping", which looks like a "hollowing out" of the optic nerve head (picture 1). Glaucoma is typically, though not always, associated with elevated intraocular pressure.
Angle-closure glaucoma is a form of glaucoma characterized by narrowing or closure of the anterior chamber angle . The normal anterior chamber angle provides drainage for the aqueous humor, the fluid that fills the eyeball. When this drainage pathway is narrowed or closed, inadequate drainage of the aqueous humor leads to elevated intraocular pressure and damage to the optic nerve (figure 1A-B). Normal intraocular pressure is 8 to 21 mm Hg. In acute episodes of closed-angle glaucoma, pressures are often 30 mm Hg or higher .
Types of angle-closure glaucoma
Angle-closure glaucoma is divided into two main groups:
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- Types of angle-closure glaucoma
- Risk factors
- Primary angle-closure
- - Chronic angle-closure
- Secondary angle-closure
- CLINICAL PRESENTATION
- Diagnostic tests
- - Gonioscopy
- - Slit lamp grading of anterior chamber depth
- - Ultrasound biomicroscopy
- - Anterior segment optical coherence tomography
- - Provocative tests
- DIFFERENTIAL DIAGNOSIS
- Acute primary angle-closure glaucoma
- - Laser peripheral iridotomy
- - Other surgery
- Chronic angle-closure glaucoma
- Secondary angle-closure glaucoma
- PATIENT INSTRUCTIONS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS