Highlights & Basics
- Acute angle-closure glaucoma is an urgent but uncommon, dramatic symptomatic event with blurring of vision, painful red eye, headache, nausea, and vomiting.
- Diagnosis is made by noting high intraocular pressure, corneal edema, shallow anterior chamber, and a closed angle on gonioscopy.
- Medical or surgical therapy is directed at widening the angle and preventing further angle closure.
- If glaucoma has developed it is treated with therapies to lower intraocular pressure.
- Chronic angle-closure glaucoma is diagnosed by noting peripheral anterior synechiae on gonioscopy, as well as progressive damage to the optic nerve and characteristic visual field loss. It is treated with therapies to lower intraocular pressure.
Quick Reference
History & Exam
Key Factors
halos around lights
aching eye or brow pain
headache
nausea, vomiting
reduced visual acuity
eye redness
elevated intraocular pressure (IOP)
corneal edema
fixed dilated pupil
Other Factors
use of medications that induce angle narrowing
incidental eye findings
blurred vision
corneal hysteresis
change in vision
Diagnostics Tests
1st Tests to Order
gonioscopy, examination of anterior chamber angle
slit lamp examination
automatic static perimetry
Other Tests to consider
ultrasound biomicroscopy
anterior segment optical coherence tomography (of angle)
evaluation of the optic nerve head by fundoscopy
retinal optical coherence tomography
Heidelberg retinal tomography
GDx nerve fiber analyzer
Emerging Tests
corneal hysteresis
Treatment Options
acute
initial presentation: acute angle-closure glaucoma
carbonic anhydrase inhibitors and/or topical beta-blocker and/or topical alpha-2 agonist
topical ophthalmic cholinergic agonists
hyperosmotic agents
laser peripheral iridotomy after acute attack resolved (after corneal edema resolves)
anterior chamber paracentesis
laser peripheral iridotomy after acute attack resolved (after corneal edema resolves)
Definition
Classifications
Clinical classification
- Acute: abrupt onset of symptomatic elevation of IOP (>21 mmHg) resulting from total closure of the angle, which is not self-limiting
- Sub-acute (or intermittent): abrupt onset of symptomatic elevation of IOP, resulting from total closure of the angle, which is self-limiting and recurrent
- Chronic: elevated IOP resulting from angle closure that is asymptomatic.
Vignette
Common Vignette 1
Common Vignette 2
Other Presentations
Epidemiology
Etiology
Pathophysiology
- Mechanisms that push the iris from behind including, most commonly, relative pupillary block (where accumulation of aqueous in the posterior chamber forces the peripheral iris anteriorly, causing anterior iris bowing, narrowing of the angle, and acute or chronic angle-closure glaucoma) as well as plateau iris syndrome, enlarged or anteriorly displaced lens, and malignant glaucoma.
- Mechanisms that pull the iris into contact with the TM (e.g., contraction of inflammatory membrane as in uveitis, fibrovascular tissue as in iris neovascularization, or corneal endothelium as in iridocorneal endothelial syndrome).
Diagnostic Approach
History
Examination
Investigations
Risk Factors
History & Exam
Tests
Differential Diagnosis
Open-angle glaucoma (primary and secondary)
Differentiating Signs/Symptoms
- Clinically indistinguishable from chronic ACG.
Differentiating Tests
- Gonioscopy shows an open angle.
Differentiating Signs/Symptoms
- Visual field defects are different from those of glaucoma.
Differentiating Tests
- Intraocular pressure is normal. Gonioscopy shows an open angle. Optic nerve atrophy (whitening of tissue) in contrast to loss of tissue and cupping.
Eye trauma
Differentiating Signs/Symptoms
- Acute red eye. Usually no nausea or vomiting. History of recent trauma.
- There may be signs of trauma on eye exam and ocular adnexa (eyelid ecchymosis, hyphema, inflammation).
Differentiating Tests
- Intraocular pressure usually normal. Gonioscopy shows an open angle. The anterior chamber depth is usually normal.
Keratitis
Differentiating Signs/Symptoms
- Acute red eye. Usually no nausea or vomiting.
- Conjunctival discharge. Signs of infectious infiltrate in the cornea.
Differentiating Tests
- Intraocular pressure usually normal. Gonioscopy shows an open angle. The anterior chamber depth is usually normal.
Conjunctivitis, acute
Differentiating Signs/Symptoms
- Acute red eye. Usually no nausea or vomiting.
- Conjunctival discharge. Signs of infectious infiltrate in the cornea.
Differentiating Tests
- Intraocular pressure usually normal. Gonioscopy shows an open angle. The anterior chamber depth is usually normal.
Corneal ulcer
Differentiating Signs/Symptoms
- Acute red eye. Usually no nausea or vomiting.
- Recent foreign body, contact lens use, or known poor eye closure (e.g., facial palsy).
Differentiating Tests
- Intraocular pressure usually normal. Gonioscopy shows an open angle. The anterior chamber depth is usually normal.
Episcleritis or scleritis
Differentiating Signs/Symptoms
- Acute red eye. Usually no nausea or vomiting.
- Known systemic disease, such as rheumatoid arthritis.
Differentiating Tests
- Intraocular pressure usually normal. Gonioscopy shows an open angle. The anterior chamber depth is usually normal.
Chemical injury
Differentiating Signs/Symptoms
- Acute red eye.
- History of exposure to chemicals.
Differentiating Tests
- Intraocular pressure may be elevated, but gonioscopy shows an open angle.
Criteria
- Presence of at least 2 of the following symptoms: ocular or periocular pain, nausea and/or vomiting, an antecedent history of intermittent blurring of vision with haloes.
- Presenting intraocular pressure (IOP) >21 mmHg.
- Presence of at least 3 of the following signs: conjunctival injection, corneal epithelial edema, mid-dilated unreactive pupil, and shallow anterior chamber.
- Primary angle-closure suspect: an "occludable angle," with normal IOP, optic disk, and visual field, without evidence of peripheral anterior synechiae (PAS).
- Primary angle-closure: an "occludable angle" with either raised IOP and/or primary PAS. Optic disk and field normal.
- Primary angle-closure glaucoma: primary angle closure with evidence of glaucomatous damage to optic disk and visual field.
Screening
Which population to screen
Which test to use
Treatment Approach
Initial medical management of acute episode
Initial surgical management of acute episode
Definitive surgical management for chronic ACG and after resolution of acute attack
Persistently elevated IOP in patients with ACG despite surgery
Repeat episode of acute ACG
Treatment Options
initial presentation: acute angle-closure glaucoma
carbonic anhydrase inhibitors and/or topical beta-blocker and/or topical alpha-2 agonist
Primary Options
- dorzolamide ophthalmic
(2%) 1 drop into the affected eye(s) twice or three times daily
or
- brinzolamide ophthalmic
(1%) 1 drop into the affected eye(s) twice or three times daily
or
- acetazolamide
125-250 mg orally (immediate-release) up to four times daily, maximum 1000 mg/day; 250-500 mg intravenously every 2-4 hours, maximum 1000 mg/day
or
- methazolamide
50-100 mg orally twice or three times daily
AND/OR
- timolol ophthalmic
(0.25% or 0.5%) 1 drop into the affected eye(s) twice daily; (0.5% gel) 1 drop into the affected eye(s) once daily
or
- betaxolol ophthalmic
(0.5%) 1-2 drops into the affected eye(s) twice daily
AND/OR
- brimonidine ophthalmic
(0.1 to 0.2%) 1 drop into the affected eye(s) three times daily
- dorzolamide ophthalmic
Comments
- Carbonic anhydrase inhibitors decrease aqueous humor formation and are used commonly as first-line therapy in combination with beta-blockers and alpha-2 agonists. Topical dorzolamide and brinzolamide are preferred over systemic acetazolamide and methazolamide. Topical beta-blockers lower intraocular pressure (IOP) through suppression of aqueous humor production. Beta-blockers reduce IOP by around 20% to 25%.[37] Topical alpha-2 adrenergic agonists lower IOP through suppression of aqueous humor production. Alpha-agonists reduce IOP by around 18% to 35%.[37]
topical ophthalmic cholinergic agonists
Primary Options
- pilocarpine ophthalmic
(1-2%) 1 drop into the affected eye(s) up to four times daily
- pilocarpine ophthalmic
Comments
- When ACG is suspected to be secondary to pupillary block or plateau iris syndrome and once intra-ocular pressure (IOP) is <40 mmHg, these agents may be incorporated.
- These agents cause pupil constriction with thinning of the iris and its pulling away from the inner eye wall and trabecular meshwork, thus opening the angle.
- Instillation frequency and concentration of pilocarpine is determined by response. Patients with heavily pigmented irides may require higher strengths.
- In acute attack 1% to 2% is the preferred solution. Stronger miotics may increase the pupillary block. They can paradoxically result in shallowing of the anterior chamber and narrowing of the angle in eyes with angle closure secondary to lens-induced mechanism or aqueous misdirection. They are therefore contraindicated in these cases.
- Patients may be maintained on pilocarpine as long as IOP is controlled and no deterioration in visual fields occurs.
hyperosmotic agents
Primary Options
- mannitol
1.5 to 2 g/kg intravenously over 30 minutes
- mannitol
Comments
- If there is failure of initial medical treatment or intraocular pressure (IOP) is greater than 50 mmHg, hyperosmotic agents are used to control acute episodes of elevated IOP. They are rarely administered for longer than a few hours because their effects are transient.
- Indicated in patients when medical treatments are unsuccessful or if pressures are exceedingly high.
laser peripheral iridotomy after acute attack resolved (after corneal edema resolves)
Comments
- LPI alleviates pupillary block by allowing aqueous humor to bypass the pupil. The pressure differential between anterior and posterior chambers is eliminated, and the iris loses its convex configuration and falls away from the trabecular meshwork (TM), resulting in opening or widening of the angle. LPI is indicated in all eyes with angle closure and usually in fellow eyes as well, because both eyes usually share the same anatomic predisposition for increased pupillary block and so are at high risk for developing acute angle closure.
anterior chamber paracentesis
Comments
- If the IOP cannot be decreased with medical therapy, an anterior chamber paracentesis can offer immediate resolution. This often results in the clearing of corneal edema, which can make performing a laser peripheral iridotomy easier. A study showed that this may also benefit the outcomes of eventual surgical intervention.[40]
- This prospective trial randomized patients to receive either paracentesis at presentation or no paracentesis at presentation, with both groups going on to have surgery (trabeculectomy). Paracentesis reduced IOP significantly in all patients, without serious adverse events. Post-trabeculectomy inflammation was seen in fewer eyes and at a lower level in the paracentesis group. In addition, the percentage of functional filtration blebs, success rate of trabeculectomy, and the rate of visual recovery were statistically significantly higher in the paracentesis group.
laser peripheral iridotomy after acute attack resolved (after corneal edema resolves)
Comments
- LPI alleviates pupillary block by allowing aqueous humor to bypass the pupil. The pressure differential between anterior and posterior chambers is eliminated, and the iris loses its convex configuration and falls away from the trabecular meshwork (TM), resulting in opening or widening of the angle. LPI is indicated in all eyes with angle closure and usually in fellow eyes as well, because both eyes usually share the same anatomic predisposition for increased pupillary block and so are at high risk for developing acute angle closure.
initial presentation: chronic angle-closure glaucoma
laser peripheral iridotomy
Comments
- LPI alleviates pupillary block by allowing aqueous humor to bypass the pupil. The pressure differential between anterior and posterior chambers is eliminated, and the iris loses its convex configuration and falls away from the trabecular meshwork (TM), resulting in opening or widening of the angle. LPI is indicated in all eyes with angle closure and usually in fellow eyes as well, because both eyes usually share the same anatomic predisposition for increased pupillary block and so are at high risk for developing acute angle closure.
residual angle closure after laser peripheral iridotomy with elevated intraocular pressure
topical prostaglandin analog and/or topical beta-blocker and/or topical alpha-2 agonist
Primary Options
- latanoprost ophthalmic
(0.005%) 1 drop into the affected eye(s) once daily at night
or
- travoprost ophthalmic
(0.004%) 1 drop into the affected eye(s) once daily at night
or
- bimatoprost ophthalmic
(0.03%) 1 drop into the affected eye(s) once daily at night
AND/OR
- timolol ophthalmic
(0.25% or 0.5%) 1 drop into the affected eye(s) twice daily; (0.5% gel) 1 drop into the affected eye(s) once daily
or
- betaxolol ophthalmic
(0.5%) 1-2 drops into the affected eye(s) twice daily
AND/OR
- brimonidine ophthalmic
(0.1 to 0.2%) 1 drop into the affected eye(s) three times daily
or
- apraclonidine ophthalmic
(0.5%) 1-2 drops into the affected eye(s) three times daily
- latanoprost ophthalmic
Comments
- These agents are typically used individually but may be used in combination as well. They may be used in refractory cases. Latanoprost has been associated with lower incidence of conjuctival hyperemia than other prostaglandin analogs.[64] Topical ophthalmic prostaglandin analogs work by increasing aqueous outflow, reaching peak effectiveness 10 to 14 hours after administration. They are the most potent intraocular pressure (IOP)-lowering agents. Latanoprost and travoprost are preferred over bimatoprost. Topical beta-blockers lower IOP through suppression of aqueous humor production. Topical alpha-2 adrenergic agonists lower IOP through suppression of aqueous humor production. Topical cholinergic agonists may or may not need to be continued.
carbonic anhydrase inhibitors
Primary Options
- dorzolamide ophthalmic
(2%) 1 drop into the affected eye(s) twice or three times daily
- dorzolamide ophthalmic
- brinzolamide ophthalmic
(1%) 1 drop into the affected eye(s) twice or three times daily
- brinzolamide ophthalmic
Secondary Options
- acetazolamide
125-250 mg orally (immediate-release) up to four times daily, maximum 1000 mg/day; 250-500 mg intravenously every 2-4 hours, maximum 1000 mg/day
- acetazolamide
- methazolamide
50-100 mg orally twice or three times daily
- methazolamide
Comments
- Carbonic anhydrase inhibitors decrease aqueous humor formation. Topical dorzolamide and brinzolamide are preferred over systemic acetazolamide and methazolamide.
- Systemic carbonic anhydrase inhibitor chronic therapy is uncommonly used because of the many adverse effects of systemic use, and should be reserved for patients with glaucoma refractory to other medical treatment.[37]
argon laser peripheral iridoplasty (when there is a component of plateau iris)
Comments
- Argon laser peripheral iridoplasty (ALPI) is a procedure during which contraction burns are placed in the peripheral iris with the aim of thinning it and pulling it away from the TM.
lens extraction surgery ± goniosynechialysis
Comments
- If residual angle closure is attributable to the lens pushing forward the iris, then lens extraction surgery with or without goniosynechialysis is considered.
topical cholinergic agonists
Primary Options
- pilocarpine ophthalmic
(1-2%) 1 drop into the affected eye(s) up to four times daily
- pilocarpine ophthalmic
Comments
- Cholinergic agents may be used if there is residual angle closure after laser treatment. These agents cause pupil constriction with thinning of the iris and its pulling away from the inner eye wall and TM, thus opening the angle.
- Instillation frequency and concentration of pilocarpine is determined by response. Patients with heavily pigmented irides may require higher strengths.
- In acute attack 1% to 2% is the preferred solution. Stronger miotics may increase the pupillary block.
- Patients may be maintained on pilocarpine as long as intraocular pressure is controlled and no deterioration in visual fields occurs.
repeat episode of acute angle-closure glaucoma
reassessment
Comments
- If the mechanism of angle closure has not been eliminated, an acute episode can recur. In this case, in addition to standard treatment of the acute episode, the clinician should look for the specific mechanism of angle closure and treat it accordingly. It is important in such cases to verify that the peripheral iridotomy is patent.
Emerging Tx
Surgical treatment for acute angle closure attacks
Surgical treatment for chronic angle-closure glaucoma
Prevention
Secondary Prevention
Follow-Up Overview
Prognosis
Monitoring
Complications
Citations
American Academy of Ophthalmology. Preferred practice pattern: primary angle closure. November 2020 [internet publication].[Full Text]
International Council of Ophthalmology. ICO guidelines for glaucoma eye care. February 2016 [internet publication].[Full Text]
American Academy of Ophthalmology. Glaucoma summary benchmarks - 2022. Dec 2022 [internet publication].[Full Text]
1. Association of International Glaucoma Societies (AGIS) 3rd consensus meeting. Florida, USA. May 2006.
2. Quigley HA, Broman AT. The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol. 2006 Mar;90(3):262-7.[Abstract]
3. Quigley HA. Number of people with glaucoma worldwide. Br J Ophthalmol. 1996 May;80(5):389-93.[Abstract][Full Text]
4. Bankes JL, Perkins ES, Tsolakis S, et al. Bedford glaucoma survey. Br Med J. 1968 Mar 30;1(5595):791-6.[Abstract][Full Text]
5. Hollows FC, Graham PA. Intra-ocular pressure, glaucoma, and glaucoma suspects in a defined population. Br J Ophthalmol. 1966 Oct;50(10):570-86.[Abstract][Full Text]
6. Bengtsson B. The prevalence of glaucoma. Br J Ophthalmol. 1981 Jan;65(1):46-9.[Abstract][Full Text]
7. Congdon N, Wang F, Tielsch JM. Issues in the epidemiology and population-based screening of primary angle-closure glaucoma. Surv Ophthalmol. 1992 May-Jun;36(6):411-23.[Abstract]
8. Foster PJ, Johnson GJ. Glaucoma in China: how big is the problem? Br J Ophthalmol. 2001 Nov;85(11):1277-82.[Abstract][Full Text]
9. He M, Foster PJ, Johnson GJ, et al. Angle-closure glaucoma in East Asian and European people. Different diseases? Eye. 2006 Jan;20(1):3-12.[Abstract]
10. Drance SM. Angle closure glaucoma among Canadian Eskimos. Can J Ophthalmol. 1973 Apr;8(2):252-4.[Abstract]
11. Alsbirk PH. Angle-closure glaucoma surveys in Greenland Eskimos. A preliminary report. Can J Ophthalmol. 1973 Apr;8(2):260-4.[Abstract]
12. Johnson GJ, Green JS, Paterson GD, et al. Survey of ophthalmic conditions in a Labrador community: II. Ocular disease. Can J Ophthalmol. 1984 Aug;19(5):224-33.[Abstract]
13. Johnson GJ, Foster PJ. Can we prevent angle-closure glaucoma? Eye. 2005 Oct;19(10):1119-24.[Abstract]
14. Klein BE, Klein R, Sponsel WE, et al. Prevalence of glaucoma. The Beaver Dam Eye Study. Ophthalmology. 1992 Oct;99(10):1499-504.[Abstract][Full Text]
15. Wensor MD, McCarty CA, Stanislavsky YL, et al. The prevalence of glaucoma in the Melbourne Visual Impairment Project. Ophthalmology. 1998 Apr;105(4):733-9.[Abstract]
16. Vajaranant TS, Nayak S, Wilensky JT, et al. Gender and glaucoma: what we know and what we need to know. Curr Opin Ophthalmol. 2010 Mar;21(2):91-9.[Abstract][Full Text]
17. American Academy of Ophthalmology. Preferred practice pattern: primary angle closure. November 2020 [internet publication].[Full Text]
18. Thomas R, George R, Parikh R, et al. Five year risk of progression of primary angle closure suspects to primary angle closure: a population based study. Br J Ophthalmol. 2003 Apr;87(4):450-4.[Abstract][Full Text]
19. Van Herick W, Shaffer RN, Schwartz A. Estimation of width of angle of anterior chamber. Incidence and significance of the narrow angle. Am J Ophthalmol. 1969 Oct;68(4):626-9.[Abstract]
20. Lowe RF. Aetiology of the anatomical basis for primary angle-closure glaucoma. Biometrical comparisons between normal eyes and eyes with primary angle-closure glaucoma. Br J Ophthalmol. 1970 Mar;54(3):161-9.[Abstract][Full Text]
21. Foster JF, Devereux JG, Alsbirk PH, et al. Detection of gonioscopically occludable angles and primary angle closure glaucoma by estimation of limbal chamber depth in Asians: modified grading scheme. Br J Ophthalmol. 2000 Feb;84(2);186-92.[Abstract][Full Text]
22. Devereux JG, Foster PJ, Baasanhu J, et al. Anterior chamber depth measurement as a screening tool for primary angle-closure glaucoma in an East Asian population. Arch Ophthalmol. 2000 Feb;118(2):257-63.[Abstract]
23. Aung T, Friedman DS, Chew PT, et al. Long-term outcomes in Asians after acute primary angle closure. Ophthalmology. 2004 Aug;111(8):1464-9.[Abstract]
24. Chong YF, Irfan S, Menege MS. AACG: an evaluation of a protocol for acute treatment. Eye. 1999 Oct;13(5):613-6.[Abstract]
25. Flores-Sánchez BC, Tatham AJ. Acute angle closure glaucoma. Br J Hosp Med (Lond). 2019 Dec 2;80(12):C174-9.[Abstract][Full Text]
26. Wright C, Tawfik MA, Waisbourd M, et al. Primary angle-closure glaucoma: an update. Acta Ophthalmol. 2016 May;94(3):217-25.[Abstract][Full Text]
27. Lachkar Y, Bouassida W. Drug-induced acute angle closure glaucoma. Curr Opin Ophthalmol. 2007 Mar;18(2):129-33.[Abstract][Full Text]
28. Sit AJ, Chen TC, Takusagawa HL, et al. Corneal hysteresis for the diagnosis of glaucoma and assessment of progression risk: a report by the American Academy of Ophthalmology. Ophthalmology. 2023 Apr;130(4):433-42.[Abstract][Full Text]
29. International Council of Ophthalmology. ICO guidelines for glaucoma eye care. February 2016 [internet publication].[Full Text]
30. Lai JS, Gangwani RA. Medication-induced acute angle closure attack. Hong Kong Med J. 2012 Apr;18(2):139-45.[Abstract][Full Text]
31. Gazzard G, Foster PJ, Devereux JG, et al. Intraocular pressure and visual field loss in primary angle closure and primary open angle glaucomas. Br J Ophthalmol. 2003 Jun;87(6):720-5.[Abstract]
32. Michelessi M, Lucenteforte E, Oddone F, et al. Optic nerve head and fibre layer imaging for diagnosing glaucoma. Cochrane Database Syst Rev. 2015 Nov 30;(11):CD008803.[Abstract][Full Text]
33. Zimprich L, Diedrich J, Bleeker A, et al. Corneal hysteresis as a biomarker of glaucoma: current insights. Clin Ophthalmol. 2020;14:2255-64.[Abstract][Full Text]
34. Foster PJ, Buhrmann R, Quigley HA, et al. The definition and classification of glaucoma in prevalence surveys. Br J Ophthalmol. 2002 Feb;86(2):238-42.[Abstract][Full Text]
35. American Academy of Ophthalmology. Glaucoma summary benchmarks - 2022. Dec 2022 [internet publication].[Full Text]
36. American Academy of Ophthalmology. Preferred practice pattern: comprehensive adult medical eye evaluation PPP 2020. Nov 2020 [internet publication].[Full Text]
37. European Glaucoma Society. Terminology and guidelines for glaucoma: 5th edition. 2021 [internet publication].[Full Text]
38. American Academy of Ophthalmology. Referral of persons with possible eye diseases or injury - 2014. Apr 2014 [internet publication].[Full Text]
39. Hung L, Yang CH, Chen MS. Effect of pilocarpine on anterior chamber angles. J Ocul Pharmacol Ther. 1995 Fall;11(3):221-6.[Abstract]
40. Luo KS. Application of paracentesis of anterior chamber in treatment of consistent high introcular pressure of acute angle-closure glaucoma. Int J Ophthalmol. 2011;9:1611-13.
41. Ritch R. The treatment of chronic angle-closure glaucoma. Ann Ophthalmol. 1981 Jan;13(1):21-3.[Abstract]
42. Quigley HA. Long-term follow-up of laser iridotomy. Ophthalmology. 1981 Mar;88(3):218-24.[Abstract]
43. Robin AL, Pollack IP. Argon laser peripheral iridotomies in the treatment of primary angle-closure glaucoma: long-term follow-up. Arch Ophthalmol. 1982 Jun;100(6):919-23.[Abstract]
44. Jiang Y, Chang DS, Foster PJ, et al. Immediate changes in intraocular pressure after laser peripheral iridotomy in primary angle-closure suspects. Ophthalmology. 2012 Feb;119(2):283-8.[Abstract]
45. American Academy of Ophthalmology. Laser peripheral iridotomy for pupillary-block glaucoma. Ophthalmology. 1994 Oct;101(10):1749-58.[Abstract]
46. Bayliss JM, Ng WS, Waugh N, et al. Laser peripheral iridoplasty for chronic angle closure. Cochrane Database Syst Rev. 2021 Mar 23;3:CD006746.[Abstract][Full Text]
47. Ritch R, Tham CC, Lam DS. Argon laser peripheral iridoplasty (ALPI): an update. Surv Ophthalmol. 2007 May-Jun;52(3):27988.[Abstract]
48. Aung T, Ang LP, Chen SP, et al. Acute primary angle-closure: long term intraocular pressure outcome in Asian eyes. Am J Ophthalmol. 2001 Jan;131(1):7-12.[Abstract]
49. Bain WE. The fellow eye in acute closed-angle glaucoma. Br J Ophthalmol. 1957 Apr;41(4):193-9.[Abstract][Full Text]
50. Hyams SW, Friedman Z, Keroub C. Fellow eye in angle-closure glaucoma. Br J Ophthalmol. 1975 Apr;59(4):207-10.[Abstract]
51. Lowe RF. Acute angle-closure glaucoma. The second eye: an analysis of 200 cases. Br J Ophthalmol. 1962 Nov;46(11):641-50.[Abstract][Full Text]
52. Radhakrishnan S, Chen PP, Junk AK, et al. Laser peripheral iridotomy in primary angle closure: a report by the American Academy of Ophthalmology. Ophthalmology. 2018 Jul;125(7):1110-20.[Abstract][Full Text]
53. Ritch R. Argon laser peripheral iridoplasty: an overview. J Glaucoma. 1992;1:206-13.
54. Harasymowycz PJ, Papamatheakis DG, Ahmed I, et al. Phacoemulsification and goniosynechialysis in the management of unresponsive primary angle closure. J Glaucoma. 2005 Jun;14(3):186-9.[Abstract]
55. Teekhasaenee C, Ritch R. Combined phacoemulsification and goniosynechialysis for uncontrolled chronic ACG after acute angle-closure glaucoma. Ophthalmology. 1999 Apr;106(4):669-74.[Abstract]
56. Wishart PK, Atkinson PL. Extracapsular cataract extraction and posterior chamber lens implantation in patients with primary chronic angle-closure glaucoma: effect on intraocular pressure control. Eye. 1989;3(Pt 6):706-12.[Abstract]
57. Greve EL. Primary ACG: extracapsular cataract extraction or filtrating procedure? Int Ophthalmol. 1988;12:157-62.[Abstract]
58. Gunning FP, Greve EL. Lens extraction for uncontrolled glaucoma. J Cataract Refract Surg. 1998 Oct;24(10):1347-56.[Abstract]
59. American Academy of Ophthalmology. Preferred practice pattern: Primary open-angle Glaucoma PPP 2020. Nov 2020 [internet publication].[Full Text]
60. Chen MJ, Chen YC, Chou CK, et al. Comparison of the effects of latanoprost and travoprost on intraocular pressure in chronic angle-closure glaucoma. J Ocul Pharmacol Ther. 2006 Dec;22(6):449-54.[Abstract]
61. Aung T, Chan YH, Chew PT. EXACT Study Group. Degree of angle closure and the intraocular pressure-lowering effect of latanoprost in subjects with chronic angle-closure glaucoma. Ophthalmology. 2005 Feb;112(2):267-71.[Abstract]
62. Aung T, Tow SL, Yap EY, et al. Trabeculectomy for acute primary angle closure. Ophthalmology. 2000 Jul;107(7):1298-302.[Abstract][Full Text]
63. Tseng VL, Coleman AL, Chang MY, et al. Aqueous shunts for glaucoma. Cochrane Database Syst Rev. 2017 Jul 28;(7):CD004918.[Abstract][Full Text]
64. Honrubia F, García-Sánchez J, Polo V, et al. Conjunctival hyperaemia with the use of latanoprost versus other prostaglandin analogues in patients with ocular hypertension or glaucoma: a meta-analysis of randomised clinical trials. Br J Ophthalmol. 2009 Mar;93(3):316-21.[Abstract][Full Text]
65. Masselos K, Bank A, Francis IC, et al. Corneal indentation in the early management of acute angle closure. Ophthalmology. 2009 Jan;116(1):25-9.[Abstract]
66. Lam DS, Tham CC, Lai JS, et al. Current approaches to the management of acute primary angle closure. Curr Opin Ophthalmol. 2007 Mar;18(2):146-51.[Abstract]
67. Francis BA, Singh K, Lin SC, et al. Novel glaucoma procedures: a report by the American Academy of Ophthalmology. Ophthalmology. 2011 Jul;118(7):1466-80.[Abstract]
68. Chai C, Loon SC. Meta-analysis of viscocanalostomy versus trabeculectomy in uncontrolled glaucoma. J Glaucoma. 2010 Oct-Nov;19(8):519-27.[Abstract]
69. Wang X, Khan R, Coleman A. Device-modified trabeculectomy for glaucoma. Cochrane Database Syst Rev. 2015 Dec 1;(12):CD010472.[Abstract][Full Text]
70. Jackson ML, Virgili G, Shepherd JD, et al. Vision rehabilitation preferred practice pattern®. Ophthalmology. 2023 Mar;130(3):P271-335.[Full Text]
71. Ang LP, Aung T, Chua WH, et al. Visual field loss from primary angle-closure glaucoma: a comparative study of symptomatic and asymptomatic disease. Ophthalmology. 2004 Sep;111(9):1636-40.[Abstract]
72. Salmon JF. Long-term intraocular pressure control after Nd:YAG laser iridotomy in chronic angle-closure glaucoma. J Glaucoma. 1993 Winter;2(4):291-6.[Abstract]
73. Rosman M, Aung T, Ang LP, et al. Chronic angle-closure with glaucomatous damage: longterm clinical course in a North American population and comparison with an Asian population. Ophthalmology. 2002 Dec;109(12):2227-31.[Abstract]
74. Kavitha S, Ramulu PY, Venkatesh R, et al. Resolution of visual dysphotopsias after laser iridotomy: six-month follow-up. Ophthalmology. 2019 Mar;126(3):469-71.e1.[Abstract][Full Text]
Key Articles
Referenced Articles
Guidelines
Diagnostic
Summary
Provides guidance on the diagnosis of primary angle-closure glaucoma.Published by
American Academy of Ophthalmology
Published
2022
Summary
This guideline covers the diagnosis of patients with primary angle closure.Published by
American Academy of Ophthalmology
Published
2020
Summary
This guideline reviews comprehensive medical eye evaluation for adults.Published by
American Academy of Ophthalmology
Published
2020
Summary
International guidelines summary for the evaluation of glaucoma.Published by
International Council of Ophthalmology
Published
2016
Summary
Evidence-based guidelines to support ophthalmologists in diagnosing glaucoma.Published by
European Glaucoma Society
Published
2021
Treatment
Summary
Practice guidelines for the care process of vision rehabilitation, including recommended interventions for reading, daily living activities, safety, community participation, and psychosocial well-being.Published by
American Academy of Ophthalmology
Published
2022
Summary
Provides guidance on the treatment of primary angle-closure glaucoma.Published by
American Academy of Ophthalmology
Published
2022
Summary
This guideline covers the management and follow-up of patients with primary angle closure.Published by
American Academy of Ophthalmology
Published
2020
Summary
This guideline reviews comprehensive medical eye evaluation for adults.Published by
American Academy of Ophthalmology
Published
2020
Summary
International guidelines summary for the management of glaucoma.Published by
International Council of Ophthalmology
Published
2016