Primary Angle-Closure Glaucoma Workup

Updated: Nov 19, 2021
  • Author: Clement Chee-yung Tham, MBBCh, MA, FRCS(Glasg); Chief Editor: Hampton Roy, Sr, MD  more...
  • Print

Imaging Studies

Spectral-domain optical coherence tomography

In patients with glaucoma, analysis of serial retinal nerve fiber layer thickness (RNFL) maps generated with spectral-domain optical coherence tomography (OCT) can aid in the detection of RNFL progression. [13]  


Other Tests

Intraocular pressure (IOP) assessment

Goldmann applanation tonometry remains the gold standard for IOP assessment.

The accuracy of the measurement may be affected by the central corneal thickness, so the measurement of the corneal thickness (usually via ultrasound pachymetry) is important.


Static and dynamic (indentation) gonioscopy is used to evaluate and document the extent, the nature (appositional versus synechial), and the cause of the angle closure.

Optic nerve head and 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 (red-free light) 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); OCT

Visual fields  [43]

Threshold testing by automated perimetry

Special programs, such as SWAP, may help identify early visual field losses.

Further investigations to delineate the mechanism of angle closure

Ultrasound biomicroscopy examination [44, 45]

Anterior segment OCT (AS-OCT) [46]


Histologic Findings

Peripheral anterior synechiae (PAS) across chamber angle, pigment deposition in trabecular meshwork



There is no formal staging for primary angle-closure glaucoma (PACG), but grading systems (eg, Shaffer, Spaeth) exist to allow a more objective documentation of the openness of the drainage angle.