eMedicine Specialties > Emergency Medicine > Ophthalmology

Glaucoma, Acute Angle-Closure: Follow-up

Author: Ayim K Darkeh, MD, Assistant Professor, Department of Emergency Medicine, State University of New York Downstate Medical Center
Coauthor(s): Mark A Silverberg, MD, FACEP, MMB, Assistant Professor, Assistant Residency Director, Department of Emergency Medicine, State University of New York Downstate College of Medicine; Consulting Staff, Department of Emergency Medicine, Staten Island University Hospital, Kings County Hospital, University Hospital, State University of New York Downstate at Brooklyn
Contributor Information and Disclosures

Updated: Aug 12, 2009

Follow-up

Further Inpatient Care

  • A low threshold for admission should be used with acute angle-closure glaucoma (AACG) patients. Patients who received osmotic agents may require electrolyte and volume status monitoring. Immediate ophthalmic follow-up care must be scheduled, and, at certain institutions, admission will help its facilitation.

Further Outpatient Care

  • Patients will remain on oral acetazolamide, pilocarpine, and beta-blockers or alpha-agonists until definitive treatment. After laser peripheral iridotomy (LPI), 33% of patients will require topical medication to maintain lower intraocular pressure (IOP).

Deterrence/Prevention

  • Fellow eye surgery

Complications

Prognosis

  • Several studies evaluated patients after treatment for AACG and demonstrated favorable outcomes. With adequate treatment, most patients recover their lost vision. In whites, IOP was controlled with LPI alone in 65-76%. Asians more often have medically refractory initial attacks and require medications after LPI.3 They also have higher rates of visual field loss and subsequent increases in IOP.3 It has been hypothesized that the initial attack is often more severe in Asians resulting in greater trabecular damage. Another possibility is the formation of peripheral synechiae (adhesions) causing a creeping angle reclosure.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • To reduce the risk of lawsuits, emergency physicians should make the diagnosis and obtain an ophthalmic consult as soon as possible.
 


More on Glaucoma, Acute Angle-Closure

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

  1. Berkoff DJ, Sanchez LD. An uncommon presentation of acute angle closure glaucoma. J Emerg Med. Jul 2005;29(1):43-4. [Medline].

  2. Yip LW, Aquino MC, Chew PT. Measurement of anterior lens growth after acute primary angle-closure glaucoma. Can J Ophthalmol. Apr 2007;42(2):321-2. [Medline].

  3. Ang LP, Ang LP. Current understanding of the treatment and outcome of acute primary angle-closure glaucoma: an Asian perspective. Ann Acad Med Singapore. Mar 2008;37(3):210-5. [Medline].

  4. Rahim SA, Sahlas DJ, Shadowitz S. Blinded by pressure and pain. Lancet. Jun 25-Jul 1 2005;365(9478):2244. [Medline].

  5. Cholongitas E, Pipili C, Dasenaki M. Acute angle closure glaucoma presented with nausea and epigastric pain. Dig Dis Sci. May 2008;53(5):1430-1. [Medline].

  6. Croos R, Thirumalai S, Hassan S, Davis Jda R. Citalopram associated with acute angle-closure glaucoma: case report. BMC Ophthalmol. Oct 4 2005;5:23. [Medline].

  7. Choong YF, Irfan S, Menage MJ. Acute angle closure glaucoma: an evaluation of a protocol for acute treatment. Eye. Oct 1999;13 (Pt 5):613-6. [Medline].

  8. Mansouri K, Ravinet E. Argon-laser iridoplasty in the management of uveitis-induced acute angle-closure glaucoma. Eur J Ophthalmol. Mar-Apr 2009;19(2):304-6. [Medline].

  9. Ang LP, Aung T, Chua WH, Yip LW, Chew PT. Visual field loss from primary angle-closure glaucoma: a comparative study of symptomatic and asymptomatic disease. Ophthalmology. Sep 2004;111(9):1636-40. [Medline].

  10. Aung T, Friedman DS, Chew PT, Ang LP, Gazzard G, Lai YF, et al. Long-term outcomes in Asians after acute primary angle closure. Ophthalmology. Aug 2004;111(8):1464-9. [Medline].

  11. Aung T, Oen FT, Wong HT, et al. Randomised controlled trial comparing the effect of brimonidine and timolol on visual field loss after acute primary angle closure. Br J Ophthalmol. Jan 2004;88(1):88-94. [Medline].

  12. Blake DR, Nathan DM. Acute angle closure glaucoma following rapid correction of hyperglycemia. Diabetes Care. Nov 2003;26(11):3197-8. [Medline].

  13. Bonomi L, Marchini G, Marraffa M, et al. Epidemiology of angle-closure glaucoma: prevalence, clinical types, and association with peripheral anterior chamber depth in the Egna-Neumarket Glaucoma Study. Ophthalmology. May 2000;107(5):998-1003. [Medline].

  14. Fourman S. Diagnosing acute angle-closure glaucoma: a flowchart. Surv Ophthalmol. May-Jun 1989;33(6):491-4. [Medline].

  15. Fricke TR, Mantzioros N, Vingrys AJ. Management of patients with narrow angles and acute angle-closure glaucoma. Clin Exp Optom. Nov 1998;81(6):255-266. [Medline].

  16. Gohdo T, Tsumura T, Iijima H, Kashiwagi K, Tsukahara S. Ultrasound biomicroscopic study of ciliary body thickness in eyes with narrow angles. Am J Ophthalmol. Mar 2000;129(3):342-6. [Medline].

  17. Kramer P, Ritch R. The treatment of acute angle-closure glaucoma revisited. Ann Ophthalmol. Dec 1984;16(12):1101-3. [Medline].

  18. Lam D, Tham C, Lai J, et al. Current approaches to management of acute primary angle closure. Curr Opinion Ophthalmol. 2001;18:146-151.

  19. Lim LS, Aung T, Husain R, Wu YJ, Gazzard G, Seah SK. Acute primary angle closure: configuration of the drainage angle in the first year after laser peripheral iridotomy. Ophthalmology. Aug 2004;111(8):1470-4. [Medline].

  20. Lowe RF. Aetiology of the anatomical basis for primary angle-closure glaucoma. Biometrical comparisons between normal eyes and eyes with primary angle-closure glaucoma. Br J Ophthalmol. Mar 1970;54(3):161-9. [Medline].

  21. MacCumber M. Management of Ocular Injuries and Emergencies. 1998:237-240.

  22. Markowitz SN, Morin JD. Angle-closure glaucoma: relation between lens thickness, anterior chamber depth and age. Can J Ophthalmol. Dec 1984;19(7):300-2. [Medline].

  23. Ritch R. Assessing the treatment of angle closure. Ophthalmology. Oct 2003;110(10):1867-8. [Medline].

  24. Salmon JF. The management of acute angle-closure glaucoma. Eye. Oct 1999;13 (Pt 5):609-10. [Medline].

  25. Saw SM, Gazzard G, Friedman DS. Interventions for angle-closure glaucoma: an evidence-based update. Ophthalmology. Oct 2003;110(10):1869-78; quiz 1878-9, 1930. [Medline].

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Further Reading

Related eMedicine topics
 
Glaucoma, Angle Closure, Acute (from Ophthalmology)
Glaucoma, Drug-Induced (Ophthalmology)
Sudden Visual Loss (from Ophthalmology)  

Guidelines

Primary Angle Closure  

Glaucoma  

Clinical studies
 
ALPI vs Medical Therapy Effects on Optic Nerve Structure & Function (Iridoplasty)

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Keywords

acute angle-closure glaucoma, acute angle closure glaucoma, acute angle closure, AACG, primary angle closure, primary angle-closure glaucoma, increased intraocular pressure, decreased visual acuity, increased IOP

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Contributor Information and Disclosures

Author

Ayim K Darkeh, MD, Assistant Professor, Department of Emergency Medicine, State University of New York Downstate Medical Center
Ayim K Darkeh, MD is a member of the following medical societies: American College of Emergency Physicians, Emergency Medicine Residents Association, National Medical Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Mark A Silverberg, MD, FACEP, MMB, Assistant Professor, Assistant Residency Director, Department of Emergency Medicine, State University of New York Downstate College of Medicine; Consulting Staff, Department of Emergency Medicine, Staten Island University Hospital, Kings County Hospital, University Hospital, State University of New York Downstate at Brooklyn
Mark A Silverberg, MD, FACEP, MMB is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Michelle Ervin, MD, Chair, Department of Emergency Medicine, Howard University Hospital
Michelle Ervin, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, National Medical Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Douglas Lavenburg, MD, Clinical Professor, Department of Emergency Medicine, Christiana Care Health Systems
Douglas Lavenburg, MD is a member of the following medical societies: American Society of Cataract and Refractive Surgery
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Steven C Dronen, MD, FAAEM, Director of Emergency Services, Director of Chest Pain Center, Department of Emergency Medicine, Ft Sanders Sevier Medical Center
Steven C Dronen, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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