Closed-angle glaucoma, also called acute glaucoma, is rare, but should be treated immediately, and should be considered a medical emergency.
It occurs when, with a primary angular closure, in which the angle forming the iris and the cornea narrows, causing the aqueous humour drainage system to close suddenly.
The causes are unknown, but some risk factors have been identified, in addition to age and sex, as it occurs more in women than in men.
These include having a family history of glaucoma, the size of the anterior chamber of the eye being less than usual, hypermetropia, being subjected to strong nervous tension or stress or the use of anticholinergic, sympathomimetic, mydriatic or anxiolytic drugs.
Contrary to what happens in other types of glaucoma, in this case the symptoms are clearly noticeable from the first moment and will be more intense the higher the intraocular pressure (IOP):
- Pain that starts in the eye and can extend to the category of headache and even affect the neck and the trigeminal nerve.
- Disturbances of vision, with blurred vision and perception of a halo around light sources.
- Reddening of the eye
- Changes in the colour of the iris
- CORNEAL Surgery
- Dilation of the pupil
- Nausea and vomiting
Treatment should be performed as soon as possible, immediately, since any damage that may have occurred in the retina will be irreversible.
The priority is to reduce IOP by pharmacological treatment. If the IOP is not lowered, surgical intervention should be performed to restore the drainage of the aqueous humour. If that time is shorter, it may take a few hours.
The surgical technique used in this case will be an iriditomy. Usually, this procedure is carried out on both eyes, since when a closed-angle glaucoma occurs in one of them it is usual to do so later in the other.
The iriditomy is a quick and simple procedure that is performed on an outpatient basis, with local anaesthesia and in which a laser is used across the iris border to create a communication path between the anterior and posterior chambers of the eye, so that the aqueous humour solution can pass from the second to the first, thus restoring drainage.
The patient may return home shortly afterwards and resume a practically normal life, although it is recommended not to drive for two days following the procedure.
Results of the operation
The effectiveness of surgical treatment for closed-angle glaucoma is very high and the results are clearly seen between 24 and 72 hours following the procedure.
In a few cases a new intervention may be necessary, but in general, despite the damages suffered by the acute attack, they are irreversible, and the recovery of the patient is optimal. However, it will be necessary to establish a schedule of periodic reviews that allow monitoring of the state of the eye.