Angle Closure and Its Treatment

Glaucoma comes in different forms. There are two basic types:open-angle and closed or narrow angle glaucoma. Of the two types open angle glaucoma is the more common of the two. Angle closure glaucoma can result in more rapid loss of vision and must be treated immediately. Open angle glaucoma can exist for many years lurking in the background. Angle closure glaucoma patients usually present with a painful red eye accompanied by blurry vision, extreme pain as well as nausea and vomiting. It is caused by the sudden blockage of fluid circulation in the eye, specifically fluid getting into the “drain” or angle of the eye. The angle is where the iris (the colored part) meets the cornea (the clear covering in the front). when the angle cluses the fluid that the eye naturally produces has nowhere to exit or drain. this causes the pressure in the eye to rapidly rise. Normal eye pressure ranges to about 20 mm Hg but with an attack of galucoma the pressure can go as high 70 mm Hg. This rapid rise will often lead to pronounced vision loss in hours to days rather than over months to years as seen in open angle glacoma.

Prompt treatment for angle closure is a must to avoid total loss of vision. While medications are administered the mainstay of treatment is with a laser iridotomy to hopefully break the attack. This treatment creates a small hole in the iris where fluid can now pass which in turn helps the drain, or angle, open to allow fluid passage. I use the analogy of our bathroom sinks at home. If you were to put the drain plug in and leave the water on, eventually the sink will fill. The auxiliary drain in the front of the sink however prevents the water from overflowing onto the floor. The laser iridotomy creates an opening that acts like the auxiliary drain in the bathroom sink. One important fact is that once you have an attack in 1 eye you are at great risk for an attack in the other eye. We will always perform a preventative laser in the unaffected eye to prevent a future attack. While no procedure is foolproof, the likelihood of an angle closure attack after a successful iridotomy is close to zero. The laser treatment itself is easily performed and with no pain or discomfort. Only eye drops are used as anesthesia and activities do not have to be limited following the procedure.

Patients who are at risk include those who are moderately to severely far-sighted, the use of some medications, older age and women. Most patients who are at risk for angle closure glaucoma are unaware of the risk. Therefore it is important to have regular eye exams where your ophthalmologist can check you to determine is you are at risk and then can discuss the need for preventative treatment to reduce that risk.Call SightMD today to schedule your consultation.

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