Glaucoma, Angle Closure, Acute Follow-up

  • Author: Robert J Noecker, MD, MBA; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Jan 5, 2011
 

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.
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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.
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Inpatient & Outpatient Medications

  • See Further Outpatient Care.
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Complications

  • Loss of vision can occur without prompt treatment.
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Prognosis

  • The prognosis is favorable with early detection and treatment.
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Patient Education

  • Inform the patient to promptly seek professional treatment if pain and/or decreased vision occur.
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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: Allergan Consulting fee Consulting; Allergan, Zeiss, Lumenis Grant/research funds Other; Allergan, Alcon, Lumenis, Endo-optics Honoraria Speaking and teaching

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

Specialty Editor Board

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.

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.

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: Nothing to disclose.

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.

References

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

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

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

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

  5. Wang BS, Narayanaswamy A, Amerasinghe N, Zheng C, He M, Chan YH, et al. Increased iris thickness and association with primary angle closure glaucoma. Br J Ophthalmol. Jan 2011;95(1):46-50. [Medline].

  6. 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].

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

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

  10. 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].

 
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