eMedicine Specialties > Ophthalmology > Intraocular Pressure

Glaucoma, Angle Closure, Chronic: Differential Diagnoses & Workup

Author: Robert Ritch, MD, Chief of Glaucoma Service, Surgeon Director, Professor, Department of Ophthalmology, New York Eye and Ear Infirmary
Coauthor(s): Clement CY Tham, BM BCh(Oxford), FRCS(Glasgow), FCOphth(HK), Professor, Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong; Honorary Consultant, Department of Ophthalmology, Queen Mary Hospital, Hong Kong
Contributor Information and Disclosures

Updated: Jun 2, 2006

Differential Diagnoses

Central Retinal Vein Occlusion
Glaucoma, Malignant
Choroidal Detachment
Glaucoma, Phacomorphic
Dystrophy, Fuchs Endothelial
Pupillary Block, Aphakic
Episcleritis
Retinopathy of Prematurity

Other Problems to Be Considered

Glaucoma associated with shallow anterior chamber

Primary angle closure
Plateau iris syndrome
Relative pupillary block (most common)
Secondary angle closure
Choroidal hemorrhage (acute)
Ciliochoroidal effusion
Acquired immunodeficiency syndrome (AIDS)
Arteriovenous malformations
Inflammation
Nanophthalmos
Trauma
Tumor
Uveal effusion syndrome
Cystinosis
Drug-induced acute transitory myopia (eg, diuretics, sulfonamides)
Elevated episcleral venous pressure associated with arteriovenous fistula
Hemorrhagic retinal
Hyperglycemia (acute)
Inflammation
Iridocyclitis with posterior synechiae and iris bombé
Posterior scleritis
Intraocular tumor (posterior segment melanoma, metastatic carcinoma, retinoblastoma, medulloepithelioma)
Lens dislocation
Luetic interstitial keratitis
Maroteaux-Lamy syndrome (MPS VI)
Multiple cysts of the iris and ciliary body
Nanophthalmos
Persistent hyperplastic primary vitreous (PHPV)
Phakic pupillary block
Postoperative panretinal photocoagulation
Postoperative scleral buckle
Retinal dysplasia

Workup

Other Tests

  • Intraocular pressure
  • Gonioscopy - Static and dynamic (indentation)
  • Optic nerve head (ONH) and retinal nerve fiber layer (RNFL) assessments
    • Qualitative
      • Slit lamp biomicroscopy examination using noncontact lenses (eg, 90-D lens) or contact lenses (eg, central lens in Goldmann 3-mirror lens). Green filter may aid in the identification of RNFL thinning.
      • Fundus photography for documentation (stereoscopic or nonstereoscopic)
    • Quantitative
      • GDx VCC nerve fiber analyzer
      • Heidelberg retinal tomography (HRT)
      • Optical coherence tomography (OCT)
  • Visual fields – Threshold testing by automated perimetry
  • Further investigation to delineate mechanism of angle closure – Ultrasound biomicroscopy (UBM) examination

Histologic Findings

PAS across chamber angle

More on Glaucoma, Angle Closure, Chronic

Overview: Glaucoma, Angle Closure, Chronic
Differential Diagnoses & Workup: Glaucoma, Angle Closure, Chronic
Treatment & Medication: Glaucoma, Angle Closure, Chronic
Follow-up: Glaucoma, Angle Closure, Chronic
References
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References

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Further Reading

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Keywords

CACG, chronic angle-closure glaucoma, plateau iris, miotic-induced angle-closure glaucoma, combined mechanism glaucoma, mixed mechanism glaucoma, peripheral anterior synechiae, PAS, anterior chamber angle

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Contributor Information and Disclosures

Author

Robert Ritch, MD, Chief of Glaucoma Service, Surgeon Director, Professor, Department of Ophthalmology, New York Eye and Ear Infirmary
Robert Ritch, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Medical Association, American Ophthalmological Society, Chinese American Medical Society, International College of Surgeons, New York Academy of Medicine, and New York Academy of Sciences
Disclosure: Nothing to disclose.

Coauthor(s)

Clement CY Tham, BM BCh(Oxford), FRCS(Glasgow), FCOphth(HK), Professor, Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong; Honorary Consultant, Department of Ophthalmology, Queen Mary Hospital, Hong Kong
Disclosure: Nothing to disclose.

Medical Editor

Andrew I Rabinowitz, MD, Consulting Staff, Department of Ophthalmology, Barnet Dulaney Perkins Eye Center
Andrew I Rabinowitz, MD is a member of the following medical societies: Aerospace Medical Association, American Academy of Ophthalmology, and American Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Martin B Wax, MD, Clinical Professor, Department of Ophthalmology, University of Texas Southwestern Medical School; Vice President, Ophthalmology Research and Development, Head, Ophthalmology Discovery Research, Alcon Labs, Inc
Martin B Wax, MD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Society for Neuroscience
Disclosure: Alcon Labs Salary Employment

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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