ANGLE CLOSURE GLAUCOMA
A completely different storyPRIMARY ANGLE CLOSURE GLAUCOMA (PACG)
PREDISPOSING FACTORS:ANATOMICAL:HYPERMETROPIAANTERIORLY DISPLACED IRIS –LENS DIAPHRAGMNARROW ANGLE AC. (small eye, large lens, small cornea, big ciliary body)PLATEAU IRIS CONFIGURATIONPREDISPOSING FACTORS (CONT.)
GENERAL: AGE (5TH -6TH DECADE) GENDER(FEMALE 4:1 ) RACE (SOUTH EAST ASIA, CAUCASIANS ) NERVOUS PERSON WITH VASOMOTOR INSTABILITY RAINY SEASONS FAMILY HISTORYPRECIPATATING FACTORS
DIM ILLUMINATION EMOTIONAL STRESS MYDRIATIC AGENTS( E.G. ATROPIN)MECHANISM
CASCADE OF EVENTS MID DILATATION OF THE PUPIL RELATIVE PUPILLARY BLOCK IRIS BOMBE APPOSITIONAL ANGLE CLOSURE SYNECHIAL ANGLE CLOSURECLINICAL PRESENTATION
LATENT PACG SUBACUTE PACG ACUTE PACG POST CONGESTIVE ACG CHRONIC ACG ABSOLUTE GLAUCOMALATENT PACG
SHALLOW AC (OCCLUDABLE ANGLE) ROUTINE EXAM. OR FELLOW EYE EXAM. Eclipse sign Slit lamp (AC depth, Von Herick) Gonioscopy (Shaffer) Dark room - prone test, mydriatic test Laser iriditomySUBACUTE PACG
TANSIENT ATTAKS OF IOP RISE , Pain, halos, headache, blurred vision Self termination, may be recurrent Laser iriditomyACUTE PACG
ACUTE FULL BLOWN PICTURE (NOT SELF TERMINATING) Pain, Blurred vision, lacrimation photophobia, redness Lid, conj., cornea, AC, pupil, optic disc, IOPTREATMENT :(Emergency) Hospital admission Reduce IOP medically Therapeutic choice: Iriditomy Vs. Filtration surgery Never forget the fellow eye
POSTCONGESTIVE ACG
FOLLOWING UNTREATED OR IMPROPERLY TREATED ACG VOGT TRIAD LASER IRIDITOMY OR FILTRATION SURGERYCHRONIC GLAUCOMA
HIGH IOP PATHOLOGICAL CUPPING VISUAL FIELD DEFECT WHITE EYE SIMILAR TO POAG BUT, CLOSED AC ANGLE (SYNECHIA,RECURRENT SA,MIXED) FILTRATION SURGERY USUALLY NEEDED DON`T FORGET THE OYHER EYEABSOLUTE GLAUCOMA
END STAGE BLIND PAINFUL TENSE EYE BALL WITH TOTAL GLAUCOMATOUS OPTIC ATROPHY & NO LIGTH PERCEPTION TREATMENT CYCLOCRYODESTRUCTION EVISCERATION RETROBULBAR ALCOHOL INJECTION