ACUTE ANGLE CLOSURE GLAUCOMA

1. ACUTE ANGLE CLOSURE GLAUCOMA With thanks to Frank and Alan Green

2. 2 Main Types of Glaucoma Open Angle Closed Angle

3. Closed Angle Glaucoma The Drainage Angle becomes blocked by the Iris and the pressure rises

4. Closed Angle Glaucoma Rapid rise in pressure Headache and eye pain Rapid loss of vision May occur more slowly especially in Asians

5. Aqueous Humour Made continuously by Ciliary Body Nourishes Cornea and Lens Drains through the Trabecular Meshwork in the Angle of the eye

6. Circulation of Aqueous

7. Closed Angle Glaucoma With age the Lens becomes bigger The Front Chamber becomes shallower

8. Pupil Block There is increased contact between the Iris and the Lens Aqueous has difficulty getting through the Pupil

9. Closed Angle Glaucoma The Aqueous is trapped behind the Iris and pushes it into the Drainage Angle

10. IRIS CLOSES THE ANGLE

11. Treatment Immediate treatment is to lower the very high pressure by drugs Then make a hole in the Iris with a laser or by operation PERIPHERAL IRIDOTOMY

12. Peripheral Iridotomy A Peripheral Iridotomy creates a By- pass channel for the Aqueous

13. Peripheral Iridotomy

14. Closed Angle Glaucoma If the attack has been very severe and long lasting the drainage angle will have been permanently damaged and a Peripheral Iridotomy may not work completely The pressure may remain too high These patients will need a Trabeculectomy

15. When to do Peripheral Iridotomy In the other eye of a patient with definite Closed Angle Glaucoma When the ophthalmologist thinks there isa risk of closed angle glaucoma by finding an eye with a shallow front chamber

16. Prevention of Closed Angle Glaucoma A Peripheral Iridotomy will protect against angle closure if done BEFORE getting an attack by providing a BY PASS

17. Closed Angle Glaucoma in World context 28 million Chinese at risk 5 million blind in 1 eye 2 million blind in both eyes Should all those at risk be found and have Iridotomies?