Angle closure glaucoma: causes, symptoms, treatment

Definition

What is angle closure glaucoma?

Angle closure glaucoma is a condition where the pressure inside the eye becomes too high as a result of the fluid in the eye being unable to leak out to moisturize the eye. This is a serious condition.

Based on the time of occurrence, angle closure glaucoma is divided into 2, namely acute and chronic. In the acute type, the increase in eye pressure can occur suddenly and in a short time, even in a matter of hours.

Meanwhile, chronic angle closure glaucoma usually has symptoms that continue to develop over time, making it more difficult to detect in the early stages.

This disease is an emergency and must be treated immediately. Your condition will be determined by diagnosis, treatment, and prompt referral.

How common is this disease?

This type of glaucoma, when compared to other types of glaucoma (open angle), is a less common disease. In contrast to open-angle glaucoma which occurs in 90% of cases of glaucoma.

Although it can happen to anyone, angle closure glaucoma generally occurs in people aged 55-65 years.

Symptoms

What are the symptoms of angle closure glaucoma?

The symptoms of angle closure glaucoma may vary from person to person. If you have glaucoma that is acute, signs and symptoms can appear quickly and suddenly.

The features and symptoms of acute angle closure glaucoma are:

• Pain in the eye
• Headache
• Nausea or vomiting
• Blurred or foggy vision
• Seeing a rainbow or halo of light every time you stare at a luminous object
• The whites of the eyes turn red
• The size of the left and right pupils is different
• Sudden vision loss

Unlike the acute type, you may not feel any signs and symptoms if the glaucoma you are suffering from is chronic. Therefore, most people with chronic glaucoma are not aware of the existence of this disease, until the eye damage is already severe.

There may be some symptoms not listed above. If there are symptoms that worry you, consult your doctor.

Cause

What causes angle closure glaucoma?

The cause of this type of glaucoma is due to the closed drainage angle. The tears exit your eye through several channels found in the tissue between the iris (the colored part of the eye) and the cornea (the clear outer layer of the eye). This channel is called drainage.

As the iris and cornea move closer to each other, the drainage between them becomes closed. This condition will certainly block the drainage of your tears.

As a result, the tears can't get out into the drainage, and the buildup will cause pressure that can damage the nerves in the eye.

If the occurrence is sudden, this condition is called an acute attack. However, when it occurs gradually, the condition is categorized as chronic.

If not treated immediately, this condition can lead to complete loss of vision, aka blindness.

Based on the causes of glaucoma, this condition is divided into 2 types, namely primary and secondary.

1. Primary closed angle glaucoma

Primary angle closure glaucoma is not known exactly what causes it. Usually, patients do not have other diseases that cause high pressure in the eye.

However, this condition is known to occur due to abnormalities in the eyeball, such as:

• The lens size is too large
• Abnormal iris size or structure (known as plateau iris syndrome)

2. Secondary closed angle glaucoma

In contrast to the primary type, secondary angle closure glaucoma is triggered by a disease or other pre-existing health condition.

Disease or condition that then causes the iris to push or block (close) the eye drainage channel.

Some of the health conditions that can cause secondary types of glaucoma include:

• Cataract
• Ectopic lens (when the eyepiece is shifted from where it should be)
• Diabetic retinopathy
• Ischemic eye (the blood vessels to the eye are reduced)
• Uveitis (inflammation of the eye)
• Tumor

In addition to the conditions above, attacks of acute glaucoma can occur if your pupils dilate too large or too quickly. This usually occurs when:

• You enter into a dark room
• Using eye drops to dilate the pupil
• You are stressed or excited
• You use drugs such as antidepressants, cold medicines, or antihistamines

Risk factors

Who is at risk for this condition?

There are several things that increase your risk of experiencing this condition, namely:

• Are female (women 2-4 times more likely to experience this condition than men)
• Asian or Inuit descent
• Farsighted
• 50 years and over
• Have family members with the same history
• Using drugs that dilate the pupil
• Using drugs that make the iris and cornea close together, such as sulfonamide, topiramate, or phenothiazine.

If you have glaucoma in one eye, you will most likely experience it in the other eye.

Diagnosis and treatment

The information provided is not a substitute for medical advice. ALWAYS consult your doctor.

How do doctors diagnose this condition?

If you think you have acute angle closure glaucoma, visit an eye doctor immediately without delay, as this is an emergency. Your doctor may perform several tests to confirm a diagnosis, including:

• Gonioscopy
• Tonometry
• Ophthalmoscopy

How to treat angle closure glaucoma?

The first step that doctors will take to treat this type of glaucoma is to relieve the pressure inside the eye. Usually the doctor will use:

• Eye drops to shrink the pupil
• Medicines to reduce the amount of tears produced

After the pressure inside the eye has decreased slightly, your doctor may use a laser to:

• Iridotomy : make a small hole in the iris of your eye, so that the fluid in the eye flows back up. This action can be done in just a few minutes, and you can go straight home.
• Iridoplasty or gonioplasty : a procedure of pulling the corners of your iris from the tear duct.

However, in some cases, angle closure glaucoma requires surgical or surgical treatment. The following are some types of surgery that are performed to treat glaucoma:

• Cataract surgery
• Synechialysis
• Trabeculectomy
• Installation of a glaucoma drainage device

Even though glaucoma only occurs in one eye, your doctor may treat both eyes, just to be safe.

Prevention

What steps can I take to prevent this condition?

Quoted from the Mayo Clinic, here are ways to prevent angle closure glaucoma:

1. Check the eyes regularly

The best way to prevent this condition is to have your eyes checked by a doctor regularly, especially if you have a high risk. Your doctor can monitor your pressure level and how well your tears moisturize your eyes.

If your doctor considers your risk to be very high, laser treatment for prevention may be recommended.

2. Know the history of eye conditions in your family

Angle-closure glaucoma has a tendency to run in families. If you have this risk, get screened or check your family medical history more often.

3. Exercise

Regular exercise can help prevent this condition by reducing eye pressure. Talk to your doctor about the right program for your condition.

4. Wear eye protection

Serious eye injury can cause this condition. Wear eye protection when using power tools or doing sports activities in closed fields.

If you have any questions, consult your doctor for the best solution to your problem.