eMedicine Specialties > Ophthalmology > Intraocular Pressure

Glaucoma, Angle Closure, Acute: Follow-up

Author: Robert J Noecker, MD, MBA, Associate Professor, Department of Ophthalmology, University of Pittsburgh School of Medicine; Director, Glaucoma Service, Vice Chair, Department of Ophthalmology, University of Pittsburgh Medical Center Eye Center
Coauthor(s): Malik Y Kahook, MD, Clinical Instructor of Ophthalmology, Fellow in Glaucoma, Department of Ophthalmology, University of Pittsburgh Medical Center
Contributor Information and Disclosures

Updated: Jun 18, 2009

Follow-up

Further Inpatient Care

  • Because some patients may experience transient increases in IOP after peripheral iridotomy, check every patient's IOP 1 hour after laser treatment. If medical treatment has not been successful by that time, repeat gonioscopic examination to rule out the presence of peripheral anterior synechiae. If peripheral anterior synechiae are found, the patient may need gonioplasty or incisional surgery.

Further Outpatient Care

  • Once a peripheral iridotomy has been performed, the patient should continue using the medications that were chosen to treat the acute glaucoma for 1 day after leaving the hospital or clinic. Arrange a 1-day posttreatment visit. At this visit, check the IOP again, and examine the eye. After 1 day, the patient may discontinue the antiglaucoma medications that were used in the acute attack, but the patient should be maintained on corticosteroids for 1 week.
  • Examine the patient's other eye gonioscopically and biomicroscopically to assess for narrow or occluded angles, as well as for evidence of prior attacks of ACG. If evidence of prior attacks or predisposition for future angle closure is seen, prophylactic peripheral iridotomy may be considered.

Inpatient & Outpatient Medications

  • See Further Outpatient Care.

Complications

  • Loss of vision can occur without prompt treatment.

Prognosis

  • The prognosis is favorable with early detection and treatment.

Patient Education

  • Inform the patient to promptly seek professional treatment if pain and/or decreased vision occur.

Miscellaneous

Medicolegal Pitfalls

  • Failure to diagnose ACG is the most important medicolegal area. Because patients present with remarkable systemic symptoms (eg, nausea, vomiting), the eyes may be overlooked as the source of the violent reactions. Ophthalmologists must have a high index of suspicion for acute ACG.
 


More on Glaucoma, Angle Closure, Acute

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

  1. Cantor L, et al. Glaucoma. In: Basic and Clinical Science Course. Section 10. 1996-7.

  2. Epstein DL, Allingham RR, Schuman JS. Chandler and Grant's Glaucoma. 4th ed. 1997.

  3. Hitchings RA. Glaucoma: current thinking. Br J Hosp Med. Mar 20-Apr 2 1996;55(6):312-4. [Medline].

  4. Lai JS, Tham CC, Chan JC. The clinical outcomes of cataract extraction by phacoemulsification in eyes with primary angle-closure glaucoma (PACG) and co-existing cataract: a prospective case series. J Glaucoma. Feb 2006;15(1):47-52. [Medline].

  5. Liesegang TJ. Glaucoma: changing concepts and future directions. Mayo Clinic Proceedings. 1996;71:689-694.

  6. Nolan W. Anterior segment imaging: ultrasound biomicroscopy and anterior segment optical coherence tomography. Curr Opin Ophthalmol. Mar 2008;19(2):115-21. [Medline].

  7. Shields MB. Textbook of Glaucoma. 4th ed. 1998.

  8. Sihota R, Dada T, Gupta R, et al. Ultrasound biomicroscopy in the subtypes of primary angle closure glaucoma. J Glaucoma. Oct 2005;14(5):387-91. [Medline].

  9. Xu L, Cao WF, Wang YX, Chen CX, Jonas JB. Anterior chamber depth and chamber angle and their associations with ocular and general parameters: the Beijing Eye Study. Am J Ophthalmol. May 2008;145(5):929-36. [Medline].

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Further Reading

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Keywords

acute angle glaucoma, acute angle-closure glaucoma, acute angle closure glaucoma, angle closure glaucoma, angle-closure glaucoma, ACG, narrow-angle glaucoma, narrow angle glaucoma, narrow angles, vision loss, visual deficit

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Contributor Information and Disclosures

Author

Robert J Noecker, MD, MBA, Associate Professor, Department of Ophthalmology, University of Pittsburgh School of Medicine; Director, Glaucoma Service, Vice Chair, Department of Ophthalmology, University of Pittsburgh Medical Center Eye Center
Robert J Noecker, MD, MBA is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, American Medical Association, American Society of Cataract and Refractive Surgery, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Coauthor(s)

Malik Y Kahook, MD, Clinical Instructor of Ophthalmology, Fellow in Glaucoma, Department of Ophthalmology, University of Pittsburgh Medical Center
Malik Y Kahook, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Association for Research in Vision and Ophthalmology, and Colorado Medical Society
Disclosure: Alcon Consulting fee Consulting

Medical Editor

Kilbourn Gordon III, MD, FACEP, Urgent Care Physician
Kilbourn Gordon III, MD, FACEP is a member of the following medical societies: American Academy of Ophthalmology and Wilderness Medical Society
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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