Download acut angle closure glaucoma

ACUT ANGLE CLOSURE
GLAUCOMA
PROF.DR.ÖZCAN OCAKOĞLU
ANTERIOR CHAMBER ANGLE
OPEN ANTERIOR CHAMBER ANGLE
CLOSED ANTERIOR CHAMBER ANGLE
ACUTE ANGLE CLOSURE GLAUCOMA
(AACG)
 THE ROOT OF THE IRIS OCCLUDES THE ANTERIOR
CHAMBER ANGLE AND PREVENTS THE PASSAGE OF
THE HUMOR AQUEOUS FROM THE POSTERIOR TO
THE ANTERIOR CHAMBER
 AQUEOUS CANNOT REACH OUTFLOW
PATHWAY AND COLLECTS IN THE EYEBALL
 THE RESULT IS A RAPID ELEVATION OF
INTRAOCULAR PRESSURE (IOP)
 IT IS AN OPHTHALMIC EMERGENCY AND MAY
CAUSE PERMANENT VISUAL LOSS UNLESS
MANAGED IMMEDIATELY AND PROPERLY.
THE MECHANISM OF AACG
LENS COMES IN CLOSE CONTACT WITH THE IRIS AROUND THE PUPIL
PREVENTS AQUEOUS FLUID FROM MOVING THROUGH THE PUPIL
AQUEOUS FLUID COLLECTS BEHIND THE IRIS AND CAUSES IT
TO BOW FORWARD AND CLOSE THE DRAINAGE ANGLE.
THE MOST COMMON FORM OF ANGLE CLOSURE GLAUCOMA INVOLVES
BLOCKAGE OF THE PUPIL BY THE LENS (PUPILLARY BLOCK)
PB OCCURS IN EYES THAT HAVE NARROW DRAINAGE ANGLES.
THE IRIS BOWS FORWARD IN THE PERIPHERY AND BLOCKS AQUEOUS FLUID
FROM REACHING THE TRABECULAR MESHWORK
RISK FACTORS FOR AACG

FEMALE GENDER

ASIAN POPULATION

OLDER AGE

LARGE NATURAL LENS (CATARACT)

FAR-SIGHTEDNESS (HYPEROPIA)

SHORT AXIAL LENGTH OF THE EYE

DIM ILLUMINATION

CERTAIN MEDICATIONS
 MIDRIATICS
 TOPIRAMATE
SYMPTOMS OF AACG

SEVERE OCULAR PAIN

LOSS OF VISUAL ACUITY

PHOTOPHOBIA

BLEPHAROSPASM

EPIPHORA

ALSO...
◦ HEADACHE, NAUSEA,VOMITING,
BRADYCARDIA (OCULOCARDIAC
REFLEX), SWEATING
SIGNS OF AACG

THESE FINDINGS OF ACUTE ANGLE CLOSURE
GLAUCOMA ARE SEEN IN AN EXAMINATION
BY AN EYE DOCTOR.

CLOUDY CORNEA (CORNEAL EDEMA)

RED EYES (DEEP CONJUNCTIVAL HYPEREMIA)

FORWARD BOWING IRIS (NARROW DRAINAGE
ANGLE)

SHALLOW ANTERIOR CHAMBER

MID-DILATION OF THE PUPIL (ISCHEMIA OF THE
PUPILLARY SPHINCTER)

HIGH INTRAOCULAR PRESSURE (AS HIGH AS 4X
NORMAL PRESSURE, 30-70 MM HG)
TREATMENT OF AACG
 INTRAOCULAR PRESSURE MAY BE CRITICALLY HIGH
IN ACUTE ANGLE CLOSURE GLAUCOMA.
 THE “GOALS OF TREATMENT” ARE TO LOWER THE
PRESSURE AS SOON AS POSSIBLE AND TO PREVENT
FURTHER ATTACKS.
 INITIALLY, AACG IS TREATED WITH A RANGE OF
MEDICINES THAT MAY BE GIVEN AS EYE-DROPS OR PILLS
(PILOCARPIN,BETA BLOCKERS, CARBONIC ANHIDRASE
INHIBITORS).
 IN RARE CASES INTRAVENOUS MEDICATIONS MAY
ALSO BE USED (MANNITOL ETC).
LASER PERIPHERAL IRIDOTOMY
 AFTER AN ATTACK (DEFINITIVELY TREATMENT FOR SICK EYE)
 BEFORE ANY ATTACKS OCCUR (PREVENTION FOR BOTH EYES).
 AFTER AN ATTACK (PREVENTION IN THE OTHER EYE).
YAG LASER PERIPHERAL IRIDOTOMY
YAG LASER PERIPHERAL
IRIDOTOMY