Acute angle closure glaucoma

Category: Others/ Misc

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ophthalmology- acute angle closure glaucoma


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Acute Angle Closure Glaucoma ( AACG ) Loss of vision Done by a medical student at KFU : Abdullah H. Al- Huwaiyshil For conact ..Twitter : @aha8741

Learning Objectives::

Learning Objectives: Acute glaucoma. Causes of painful diminution of vision. Eye examination. Signs and symptoms of AACG. Urgent treatment of AACG.



Anatomy & physiology of eye:

Anatomy & physiology of eye

conti ..:

conti ..

Causes of painful diminution of vision:

Causes of painful diminution of vision Acute-angle closure glaucoma Acute Iridocyclitis  Optic neuritis Uveitis Scleritis Trauma etc. ..



Acute Iridocyclitis:

Acute Iridocyclitis

Optic neuritis :

Optic neuritis



what is glaucoma?:

what is glaucoma? The term ‘’ glaucoma ‘’ covers several diseases with different etiologies that share common findings of optic neuropathy with specific pattern of visual field defects. This disease is often caused by an abnormally high intraocular pressure in the eye.

Acute Angle Closure Glaucoma:

Acute Angle Closure Glaucoma Acute episodic increase in intraocular pressure to several times than normal value ( 10-20 mm Hg ), due to sudden blockage of drainage .

Circulation of aqueous humor:

Circulation of aqueous humor

Aqueous humor circulation:

Aqueous humor circulation Ciliary process Posterior chamber Anterior chamber Canal of schlemm pupil Iridocorneal angle


AACG Increase pressure

AACG conti ..:

AACG conti .. 1st 2nd 3rd 4th

Signs and symptoms of AACG:

Signs and symptoms of AACG Acute onset of intense pain. Nausea and vomiting. Diminished visual acuity. Red eye. Severe headache. Gastrointestinal problems.

Eye examination:

Eye examination Visual acuity. Visual field. Gonioscopy. External eye examination. Ophthalmoscopy/ fundoscopy. Measuring intra ocular pressure ( IOP ).

visual acuity:

visual acuity Snellen Chart - Is read at a distance of 6m or 20 ft. - NORMAL VISION IS 6/6 OR 20/20 OR 1




• PIN HOLE HELPS DIFFERENTIATE REFRACTIVE AND NON REFRACTIVE CAUSES OF DEFECTIVE VISION. The patient of AACG won’t improve by pin hole test. Non refractive cause Pin hole

visual field:

visual field Field of perception of the eye at rest with the gaze directed straight ahead . Right eye is markedly reduced. Left eye is normal.


Examination of right eye Lid edema Severe corneal edema Complete angle closure by Gonioscopy Dilated, un-reactive, vertically oval pupil Shallow anterior chamber Ciliary injection



optic cup:

optic cup


IOP is measured by Tonometry Goldmann Perkins Pulsair 2000 (Keeler) Air-puff Schiotz Tono-Pen

intraocular pressure:

intraocular pressure Tonometry Measurements above 24 mm Hg are clinically significant. The intraocular pressure is increased.


Treatment Ocular emergency. Aim : to urgently decrease the IOP, open the closed angle, treat and prevent recurrence of pupilary block. Mainly surgical , but start medical. IOP controlled within 6 hours surgery next day No control of IOP within 6hours immediate surgery. Aim of medical treatment: Decrease intraocular pressure. Allow the cornea to clear (important for subsequent surgery). Relieve pain.


Medical Treatment of AACG 2. Hyperosmotic agents - if appropriate Oral glycerol 1-1.5 g/kg of 50% solution in lemon juice Intravenous mannitol 2g/kg of 20% solution 3. Topical therapy Pilocarpine 2% to both eyes ( miotic ): Most important Beta-blockers Steroids? 1. Acetazolamide 500 mg i.v . ( Carbonic anhydrase inhibitor) 4 . Symptomatic therapy : . with analgesic agents, antiemetic agents, and sedatives.

Treatment: surgical:

Treatment: surgical to exclude persistent angle closure glaucoma

Treatment: surgical:

Treatment: surgical laser iridotomy

laser iridotomy:

laser iridotomy

laser iridotomy:

laser iridotomy


Summary Glaucoma. Acute angle closure glaucoma. Causes of painful loss of vision. Eye examination. Treatment.


Quiz a. In AACG, the main cause is : 1) increase in IOP. 2) increase in CSF. b. With the Pin hole test, the patient of AACG will be seeing better : 1) True. 2) False. c. The most important aim of medical treatment in AACG : 1) Reliving the pain. 2) Decreasing the IOP.


Reference Gerhard K. Lang Ophthalmology 3 rd edition


Thank You Any Questions