3. TERMINOLOGIES
Primary Angle
Closure Disease :
Narrow angle of AC
Apposition of
peripheral iris against
TM Obstruction of
aqueous outflow
Primary Angle
Closure Glaucoma :
+ Optic Disc(OD)
Changes
+ Visual field
4. RISK FACTORS
Demographic Anatomic
Age – 60 to 70 y/o
Gender – M:F 1:3
Heredity – Anatomic RF
Race – SE Asians, Chinese,
Eskimos >> Blacks
HM– Short axial length,
Shallow AC
Iris – lens diaphragm
placed anteriorly
Plateau Iris config.
Narrow angle of AC
Small eyeball Large lens
Smaller D of cornea
Bigger size of CB
Anterior insertion of iris on
CB
6. PUPILLARY BLOCK
MECHANISM
Precipitating factors :
1. Physiological mydriasis – Reading in dim light,
watching tv in dark room, sympathetic overactivity
in anxiety/emotional stress.
2. Pharmacological mydriasis
• Mydriatics : Phenylephrine, Tropicamide,
Cyclopentolate, Homatropine, Atropine
• Tranquilizers
• Bronchodilators
• Anti-depressants
• Vasoconstrictors
3 Pharmacological miosis – Echothiophate, Pilocarpine
7. Mechanism :
Mydriasis mild dilatation of pupil Inc apposition
b/w iris and lens Relative Pupillary Block (RPB)
Aq. Collects in PC pushes iris anteriorly Iris
Bombe contact of iris with cornea Appositional
angle closure Inc IOP formation of peripheral ant.
Synechiae Synechial angle closure
8. Miosis contract ciliary muscles Zonules relax
lens moves forward contact of iris with lens
9. PLATEAU IRIS
• Also c/d Angle closure Glaucoma without
pupillary block.
• Insertion of iris anteriorly on ciliary body or
displacement of ciliary body anteriorly
apposition of peripheral iris with TM Plateau
iris configuration iridotomy if still acute
ACG occurs spontaneously/after pharmacological
dilation Plateau iris syndrome Miotics +
laser peripheral iridoplasty
13. 2. Slit lamp biomicroscopy – Dec axial AC depth
- Convex shaped iris-
lens diaphragm
- Close proximity of
iris to cornea in
periphery
3. Von- Herick Slit-lamp grading of angle
14. Diagnostic criteria
• Gonioscopy – iridotrabecular contact without PAS
• IOP – normal
• OD – No glaucomatous change
• VF – Normal
ANGLE IS AT RISK.
15. PACPresents in form of:
1. Asymptomatic/Quiescent PAC PACG
2. Subacute PAC
3. Acute PAC
Diagnostic criteria:
• Gonioscopy – Irido-trabecular contact
• IOP elevated and/or PAS +
• OD – normal
• VF – normal
ANGLE IS ABNORMAL EITHER IN FUNCTION (IF
INC IOP) OR IN STRUCTURE (IF PAS)
16. SUBACUTE PAC
• PPt factors Attack of transient rise in IOP
(45-55 mm HG) – lasts for a few mins to 1-2
hours.
Symptoms
• Episode – unilateral transient blurring of vision
Coloured halos around light
Headache, browache, eyeache on
affected side
• Bright light/sleep physiological miosis self
termination of attack
• Recurrent attacks – no symptoms b/w attacks
17. ACUTE PAC
• Ppt factors pupillary block sudden closure of
angle attack of rise in IOP does not
terminate on it’s own sight threatening
Symptoms
• Sudden severe pain
• Nausea, vomiting
• Rapidly progressive impairment of vision
• Redness
• Photophobia
• Lacrimation
18. Signs
• Lids – oedematous
• Conjunctiva – chemosed,
congested
• Cornea – oedematous,
insensitive
• AC – shallow
• Angle of AC – completely
closed on gonioscopy
• Iris – discoloured
• Pupil – semidilated,
vertically oval, fixed,
non reactive to
light/accomodation
• IOP – inc – b/w 40-70
mmHg
• OD – oedematous,
hyperaemic
• Fellow eye – Shallow AC,
occludable angle
19. PACG• PAC untreated gradual synechial closure of
angle of AC PACG
Diagnostic criteria:
• Inc IOP
• PAS +
• OD – glaucomatous cupping
• VFD – similar to POAG
• Gonioscopy – iridotrabecular contact
ANGLE IS ABNORMAL IN FUNCTION AND
STRUCTURE