ACUT ANGLE CLOSURE GLAUCOMA PROF.DR.ÖZCAN OCAKOĞLU

ANTERIOR CHAMBER ANGLE OPEN ANTERIOR CHAMBER ANGLE CLOSED ANTERIOR CHAMBER ANGLE

ACUTE ANGLE CLOSURE GLAUCOMA (AACG) THE ROOT OF THE IRIS OCCLUDES THE ANTERIOR CHAMBER ANGLE AND PREVENTS THE PASSAGE OF THE HUMOR AQUEOUS FROM THE POSTERIOR TO THE ANTERIOR CHAMBER AQUEOUS CANNOT REACH OUTFLOW PATHWAY AND COLLECTS IN THE EYEBALL THE RESULT IS A RAPID ELEVATION OF INTRAOCULAR PRESSURE (IOP) IT IS AN OPHTHALMIC EMERGENCY AND MAY CAUSE PERMANENT VISUAL LOSS UNLESS MANAGED IMMEDIATELY AND PROPERLY.

THE MECHANISM OF AACG LENS COMES IN CLOSE CONTACT WITH THE IRIS AROUND THE PUPIL PREVENTS AQUEOUS FLUID FROM MOVING THROUGH THE PUPIL AQUEOUS FLUID COLLECTS BEHIND THE IRIS AND CAUSES IT TO BOW FORWARD AND CLOSE THE DRAINAGE ANGLE. THE MOST COMMON FORM OF ANGLE CLOSURE GLAUCOMA INVOLVES BLOCKAGE OF THE PUPIL BY THE LENS (PUPILLARY BLOCK) PB OCCURS IN EYES THAT HAVE NARROW DRAINAGE ANGLES. THE IRIS BOWS FORWARD IN THE PERIPHERY AND BLOCKS AQUEOUS FLUID FROM REACHING THE TRABECULAR MESHWORK

RISK FACTORS FOR AACG FEMALE GENDER ASIAN POPULATION OLDER AGE LARGE NATURAL LENS (CATARACT) FAR-SIGHTEDNESS (HYPEROPIA) SHORT AXIAL LENGTH OF THE EYE DIM ILLUMINATION CERTAIN MEDICATIONS MIDRIATICS TOPIRAMATE

SYMPTOMS OF AACG SEVERE OCULAR PAIN LOSS OF VISUAL ACUITY PHOTOPHOBIA BLEPHAROSPASM EPIPHORA ALSO... HEADACHE, NAUSEA, VOMITING, BRADYCARDIA (OCULOCARDIAC REFLEX), SWEATING

SIGNS OF AACG THESE FINDINGS OF ACUTE ANGLE CLOSURE GLAUCOMA ARE SEEN IN AN EXAMINATION BY AN EYE DOCTOR. CLOUDY CORNEA (CORNEAL EDEMA) RED EYES (DEEP CONJUNCTIVAL HYPEREMIA) FORWARD BOWING IRIS (NARROW DRAINAGE ANGLE) SHALLOW ANTERIOR CHAMBER MID-DILATION OF THE PUPIL (ISCHEMIA OF THE PUPILLARY SPHINCTER) HIGH INTRAOCULAR PRESSURE (AS HIGH AS 4X NORMAL PRESSURE, 30-70 MM HG)

TREATMENT OF AACG INTRAOCULAR PRESSURE MAY BE CRITICALLY HIGH IN ACUTE ANGLE CLOSURE GLAUCOMA. THE “GOALS OF TREATMENT” ARE TO LOWER THE PRESSURE AS SOON AS POSSIBLE AND TO PREVENT FURTHER ATTACKS. INITIALLY, AACG IS TREATED WITH A RANGE OF MEDICINES THAT MAY BE GIVEN AS EYE-DROPS OR PILLS (PILOCARPIN,BETA BLOCKERS, CARBONIC ANHIDRASE INHIBITORS). IN RARE CASES INTRAVENOUS MEDICATIONS MAY ALSO BE USED (MANNITOL ETC).

LASER PERIPHERAL IRIDOTOMY AFTER AN ATTACK (DEFINITIVELY TREATMENT FOR SICK EYE) BEFORE ANY ATTACKS OCCUR (PREVENTION FOR BOTH EYES). AFTER AN ATTACK (PREVENTION IN THE OTHER EYE). YAG LASER PERIPHERAL IRIDOTOMY

YAG LASER PERIPHERAL IRIDOTOMY