Diagnosis
History
Î The patient should be asked about symptoms that may suggest
previous episodes of intermittent angle closure (e.g., blurred vision,
haloes around lights, eye pain, headache, eye redness, symptoms
following stress or dilated eye examination). (G, S)
Î Specific questioning should address the use of oral medications
that may cause ciliary body edema (e.g., sulfonamides, topiramate)
and topical, inhaled, or oral drugs with adrenergic or anticholinergic
effects (e.g., ipratropium bromide and salbutamol-containing inhalers,
phenothiazines, or other drugs with anticholinergic activity) that may
induce angle narrowing and potentially precipitate an angle-closure
attack. (G, S)
Physical Examination
Refractive Status
Î Hyperopic eyes, especially in older phakic patients, have narrower
anterior chamber angles and are at increased risk of PAC. Assessment
of actual refractive status by retinoscopy or manifest refraction in the
AACC eye may be postponed until a subsequent visit. It is appropriate
to determine the presence of hyperopia by measuring the eyeglass
power or refracting the fellow eye.
Pupil
Î For patients with suspected occludable angles, pupil dilation should
be done with caution. As appropriate, these patients should be warned
about signs and symptoms until an iridotomy has been performed,
since dilation can precipitate AACCs. (G, S)
• Size and shape (may be mid-dilated, asymmetric, or oval in the involved eye during
or following an AACC)
• Reactivity (may be poor during an AACC or nonreactive following an AACC)
• Relative afferent pupillary defect (may be present with asymmetric optic nerve
damage or be due to elevated IOP)
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