Acute angle-closure glaucoma occurs in older adults and frequently affects people with angle-closure glaucoma. This condition is called angle-closure glaucoma and occurs as either primary (onycholysis) or secondary glaucoma. The disease is the result of an injury to the drainage tract of the eye or to one of its valves.

Occurring in approximately every 100,000 individuals, acute angle-closure glaucoma accounts for more than half of all cases. However, it is rarely discovered early because the symptoms are often so subtle that they are not easy to spot. Thus, treatment of acute angle-closure glaucoma typically requires surgical intervention.

When the optic nerve is affected by acute angle-closure glaucoma, damage occurs very quickly

When this optic nerve is damaged, it can no longer respond to normal optic nerve stimulation and continues to experience very sharp, unidirectional visions. The attack occurs suddenly and abruptly disrupts normal daily activities including reading, computer use and talking. As the attack progresses, the pressure behind the eye gradually increases in intensity. Eventually, normal vision is restored only after the loss of vision has been extensive.

Symptoms of Glaucoma

In primary acute angle-closure glaucoma, the opening of an aqueous canal prevents normal drainage of the eye’s optic nerve. When this occurs, pressure builds behind the eyelids and eventually causes blindness. This is often the result of damage to one of the drainage canals, which can be either due to intrinsic or extrinsic factors.

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Intrinsic factors are those that occur naturally with age

They include

  • A buildup of intraocular pressure (IOP)
  • Myocardial infarction (MI)
  • Hypertension and atherosclerosis

Intrinsic factors are generally easy to correct through medications or surgery. Extrinsic factors on the other hand, such as excess aqueous in the ocular discharge, are difficult to correct and often require surgical intervention.

There are four types of intraocular pressure

  • The first is intraocular pressure (IOP) which is normal and maintained throughout life
  • The second is called the medial intraocular pressure (MIA), which is also normal but becomes elevated during an attack, reaches a peak during an attack and then drops below normal during the preceding phase
  • The third is called optic nerve protopathy (ONP), which refers to glaucoma caused by damage to the optic nerve
  • The fourth and rarest type of glaucoma, extrinsic angle-closure glaucoma (EAGV), occurs when there is no direct contact between the eye and an object

This type of glaucoma can lead to severe damage to vision. The treatment for acute angle-closure glaucoma depends on the severity of the optic nerve proctopathy. For milder cases, laser peripheral iridotomy may be enough to treat the disease.

Patients with acute angle-closure glaucoma have two important indicators of pain

  • The first is the eye puffiness or a raised rim of puffiness, which is called the intraocular pressure reading
  • The second is the eyeball droop, which occurs immediately after a normal attack

Drooping eyelids are called trifocals and are indicative of eye muscle spasms. Both of these indicators, however, do not necessarily mean that the patient is experiencing a painful attack, but may occur simultaneously.

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There are many different risk factors that make people more likely to develop acute angle-closure glaucoma

They include heredity, family history of CVA, diabetes, obesity, smoking, alcohol use, and past or present use of antibiotics. People who smoke, have diabetes, experience hypertension, have or use alcohol or have any other medical conditions at the same time as the patient is also at a greater risk for developing this disease. A common sign of glaucoma in the affected eye is blurred vision, along with nausea and vomiting.

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