Figure 11. Algorithm for the Management of Patients With
Acute Angle-Closure Crisis
NO
Patient with Presumed
Acute Angle-Closure
Crisis (AACC)
Treat pathology of secondary
AACC and lower IOP medically
or surgically
Topical glycerin,
compression, paracentesis,
or iridoplasty to clear the
view
YES
View clear
Evidence
for secondary
cause of AACC (NVI,
intraocular tumor, ICE
syndrome, etc.)
a
Indicated for extensive synechial closure
or optic nerve damage.
Medical therapy to break
attack and prepare patient
for laser iridotomy
Definite evidence
for PAC mechanism of
AACC
Incisional iridectomy
or cataract surgery ±
goniosynechialysis or
trabeculectomy
a
Laser
peripheral
iridoplasty or
paracentesis
Prompt
laser
iridotomy
Schedule iridotomy
in fellow eye if
chamber angle is
anatomically similar
• Dark-room gonioscopy to assess other
mechanisms of angle closure
• Ascertain continued patency of iridotomy
• Medical and surgical treatement (incisional
iridotomy or cataract surgery ± goniotomy
or trabeculectomy) to lower IOP
Follow-up with dark-
room gonioscopy to
assess adequacy of
angle opening
IOP controlled IOP uncontrolled
unsuccessful
or not possible
unsuccessful
or not possible
patient
iridotomy
11
