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British Journal of Hospital Medicine... Dec 2019Acute angle closure is an emergent ophthalmic condition that develops as a result of an obstructed outflow of aqueous humour between the anterior and posterior chambers... (Review)
Review
Acute angle closure is an emergent ophthalmic condition that develops as a result of an obstructed outflow of aqueous humour between the anterior and posterior chambers of the eye, leading to a sudden rise in intraocular pressure and secondary optic neuropathy if left untreated. The most common primary cause is a pupillary block in patients with pre-existing narrow angles, such as those who are long-sighted. However, awareness should be raised to identify secondary causes of angle closure, including the use of commonly prescribed medications. A detailed interrogation is essential to exclude other possible confounding disorders that present similarly, especially those originating in the CNS. Angle closure should be excluded in all patients presenting with sudden onset of red eye associated with pupillary dilation, dull pain and headache. Basic examination of the eye should include assessment of the anterior segment with a bright light, measurement of intraocular pressure and a full neurological exam. Immediate treatment must be initiated whenever there is high clinical suspicion of acute angle closure, with the administration of systemic ocular hypotensive therapy to prevent damage to the optic nerve and limit visual loss. An urgent referral to the ophthalmologist is mandatory to dictate definitive management.
Topics: Acute Disease; Age Factors; Diagnosis, Differential; Diagnostic Techniques, Ophthalmological; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Risk Factors; Sex Factors
PubMed: 31822188
DOI: 10.12968/hmed.2019.80.12.C174 -
American Family Physician Mar 2023Glaucoma is a group of eye disorders characterized by progressive deterioration of the optic nerve that can lead to vision loss. Primary open-angle glaucoma (POAG) is...
Glaucoma is a group of eye disorders characterized by progressive deterioration of the optic nerve that can lead to vision loss. Primary open-angle glaucoma (POAG) is the most common form in the United States. The risk of POAG increases with age, family history of glaucoma, type 2 diabetes mellitus, hypotension, hypothyroidism, obstructive sleep apnea, cardiovascular disease, and myopia. Up to one-half of patients are undiagnosed because a diagnosis often requires monitoring over years to document changes suggesting POAG. These include a cup-to-disc ratio of 0.3 or greater, intraocular pressure greater than 21 mm Hg on tonometry, nerve fiber layer defects identified on optical coherence tomography, and reproducible visual field defects. Topical intraocular pressure-lowering medications and selective laser trabeculoplasty are first-line treatments for POAG. Although POAG screening in the general adult population is not recommended, primary care physicians can help decrease POAG-related vision loss by identifying patients with risk factors and referring them for evaluation by an eye specialist. Medicare covers evaluations in patients at high risk. Primary care physicians should encourage medication adherence and identify barriers to treatment. The other type of glaucoma is angle-closure glaucoma, in which the flow of aqueous humor is obstructed. Angle-closure glaucoma can occur acutely with pupillary dilation and is an ophthalmologic emergency. The goal of treatment for acute angle-closure glaucoma is to reduce intraocular pressure quickly with medications or surgery, then prevent the recurrence of the obstruction to aqueous flow by a definitive ophthalmologic procedure.
Topics: Adult; Humans; Aged; United States; Glaucoma, Open-Angle; Glaucoma, Angle-Closure; Diabetes Mellitus, Type 2; Medicare; Glaucoma; Intraocular Pressure; Vision Disorders
PubMed: 36920817
DOI: No ID Found -
Medicina (Kaunas, Lithuania) Dec 2022Neovascular glaucoma (NVG) is a rare, aggressive, blinding secondary glaucoma, which is characterized by neovascularization of the anterior segment of the eye and... (Review)
Review
Neovascular glaucoma (NVG) is a rare, aggressive, blinding secondary glaucoma, which is characterized by neovascularization of the anterior segment of the eye and leading to elevation of the intraocular pressure (IOP). The main etiological factor is retinal ischemia leading to an impaired homeostatic balance between the angiogenic and antiangiogenic factors. High concentrations of vasogenic substances such as vascular endothelial growth factor (VEGF) induce neovascularization of the iris (NVI) and neovascularization of the angle (NVA) that limits the outflow of aqueous humor from the anterior chamber and increases the IOP. NVG clinical, if untreated, progresses from secondary open-angle glaucoma to angle-closure glaucoma, leading to irreversible blindness. It is an urgent ophthalmic condition; early diagnosis and treatment are necessary to preserve vision and prevent eye loss. The management of NVG requires the cooperation of retinal and glaucoma specialists. The treatment of NVG includes both control of the underlying disease and management of IOP. The main goal is the prevention of angle-closure glaucoma by combining panretinal photocoagulation (PRP) and antiangiogenic therapy. The aim of this review is to summarize the current available knowledge about the etiology, pathogenesis, and symptoms of NVG and determine the most effective treatment methods.
Topics: Humans; Glaucoma, Neovascular; Vascular Endothelial Growth Factor A; Glaucoma, Open-Angle; Glaucoma, Angle-Closure; Intraocular Pressure
PubMed: 36557072
DOI: 10.3390/medicina58121870 -
Die Ophthalmologie Nov 2022Angle-closure glaucoma is a rare form of glaucoma characterized by a narrow or an occlusion of the anterior chamber angle and subsequently an obstruction of the...
Angle-closure glaucoma is a rare form of glaucoma characterized by a narrow or an occlusion of the anterior chamber angle and subsequently an obstruction of the outflow of aqueous humor resulting in an increase in intraocular pressure. Symptoms can include severe eye pain and/or headache, blurred vision, a medium-sized and rigid pupil, conjunctival hyperemia, and nausea. Treatment options include pressure-lowering topical and systemic medications as well as surgical interventions, especially cataract surgery and laser iridotomy. Besides parasympathomimetics (pilocarpine), all topical antiglaucoma medications can principally be used (beta-receptor antagonists, carbonic anhydrase inhibitors, alpha‑2 selective adrenergic antagonists, prostaglandins and prostaglandin analogues). Carbonic anhydrase inhibitors and osmotic agents (e.g., mannitol) can be systemically used.
Topics: Humans; Glaucoma, Angle-Closure; Carbonic Anhydrase Inhibitors; Intraocular Pressure; Glaucoma; Anterior Chamber
PubMed: 36303042
DOI: 10.1007/s00347-022-01745-w -
Klinische Monatsblatter Fur... Aug 2023Angle-closure glaucoma is a less common form of glaucoma in Europe than open-angle glaucoma. Nevertheless, the clinical picture should also be known here since it can...
Angle-closure glaucoma is a less common form of glaucoma in Europe than open-angle glaucoma. Nevertheless, the clinical picture should also be known here since it can lead to severe visual disturbances and even blindness within a short time. It is divided into primary and secondary forms and can be further categorized depending on the presence of a pupillary block. In all cases, therapy is initially based on resolving the cause of the angle-closure and treating any underlying disease that may be present. In addition, intraocular pressure reduction must be achieved. This can be effectuated conservatively or surgically. Depending on the specific subtype of angle-closure, different treatments are promising.
Topics: Humans; Glaucoma, Angle-Closure; Glaucoma, Open-Angle; Blindness; Pupil Disorders; Europe; Intraocular Pressure
PubMed: 37236235
DOI: 10.1055/a-1812-4381 -
Ugeskrift For Laeger Nov 2023This review offers a summary of the current knowledge of pshychotropic drugs and glaucoma. If exposed to psychotropic drugs, some patients may develop angle-closure... (Review)
Review
This review offers a summary of the current knowledge of pshychotropic drugs and glaucoma. If exposed to psychotropic drugs, some patients may develop angle-closure glaucoma. Although rarely contraindicated, exposed predisposed and diagnosed patients should be followed-up by an ophthalmologist. It is still unclear if serotonin reuptake inhibitors increase the risk of angle-closure glaucoma. Tricyclic antidepressants and benzodiazepines should be used with caution in predisposed patients. The same applies to antipsychotic drugs, where first-generation antipsychotic drugs might have a smaller impact on the intraocular pressure than second-generation antipsychotic drugs.
Topics: Humans; Antipsychotic Agents; Glaucoma, Angle-Closure; Psychotropic Drugs; Glaucoma; Selective Serotonin Reuptake Inhibitors
PubMed: 38018726
DOI: No ID Found -
Eye (London, England) Dec 2022
Topics: Humans; Glaucoma, Angle-Closure; Intraocular Pressure
PubMed: 35725765
DOI: 10.1038/s41433-021-01881-8 -
International Ophthalmology May 2021Primary angle closure glaucoma is a major cause of visual morbidity in Asia, which hosts 80% of the worldwide cases. In India, primary angle closure glaucoma (PACG)... (Review)
Review
Primary angle closure glaucoma is a major cause of visual morbidity in Asia, which hosts 80% of the worldwide cases. In India, primary angle closure glaucoma (PACG) comprises almost 50% of adult glaucomas in hospital setting with its asymptomatic presentation predominating at 80%. Early diagnosis is critical to prevent the blinding trajectory of this disease, which is purported to cause twice as much blindness compared to open angle glaucoma. Traditional screening methods to identify PACG range from van Herick and flashlight test (relatively poor predictors) to gonioscopy (gold standard). Altered iris morphology are intrinsic to PACG, resulting in specific iris patterns. Iris appraisal could emerge as a method to screen underlying PACG. This would not only be specific, objective, but also easily performed at the peripheral level by a trained personnel and used in the era of tele-medicine for mass screening by AI softwares. This article seeks to detail these iris changes.
Topics: Adult; Glaucoma, Angle-Closure; Glaucoma, Open-Angle; Gonioscopy; Humans; India; Intraocular Pressure; Iris
PubMed: 33620668
DOI: 10.1007/s10792-021-01740-1 -
Ugeskrift For Laeger Sep 2021Glaucoma is the most common cause of irreversible blindness globally with a significant contribution from angle-closure glaucoma. Over the past 20 years, the terminology... (Review)
Review
Glaucoma is the most common cause of irreversible blindness globally with a significant contribution from angle-closure glaucoma. Over the past 20 years, the terminology has been standardised with the term glaucoma being used exclusively for patients with signs of glaucomatous damage to the optic nerve. Prospective randomised clinical trials have changed treatment algorithms as summarised in this review. Prophylactic iridotomy is now only offered to selected at-risk patients, while removal of the lens with phacoemulsification is more often used as the primary treatment of patients with angle closure.
Topics: Cataract Extraction; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Phacoemulsification; Prospective Studies
PubMed: 34498583
DOI: No ID Found -
European Journal of Ophthalmology Sep 2022A 45-year-old male presented with a slowly progressive, painless swelling in his right eye for the past 6 months. He had undergone an open globe injury repair...
A 45-year-old male presented with a slowly progressive, painless swelling in his right eye for the past 6 months. He had undergone an open globe injury repair 10 years back and an eventful cataract surgery 5 years back. The presenting visual acuity in the affected eye was perception of light with inaccurate projection of rays. The intraocular pressure was 44 mm Hg with advanced glaucomatous cupping. The swelling was identified to be a communicating sub-tenon cyst secondary to scleral wound dehiscence from secondary angle closure glaucoma. Wound re-suturing, cyst excision and diode laser cyclophotocoagulation was performed in a single sitting, with explained poor visual prognosis.
Topics: Humans; Male; Middle Aged; Ciliary Body; Glaucoma; Glaucoma, Angle-Closure; Intraocular Pressure
PubMed: 33985360
DOI: 10.1177/11206721211016982