Î Understanding the current disease definition is important in the
management of primary angle closure (PAC). Modern classification
includes:
• Primary angle-closure suspect (≥180° iridotrabecular contact (ITC), normal
intraocular pressure [IOP], and no optic nerve damage)
• Primary angle closure (≥180° ITC with peripheral anterior synechiae [PAS] or
elevated IOP, but no optic neuropathy)
• Primary angle-closure glaucoma (≥180° ITC with PAS, elevated IOP, and optic
neuropathy)
• Acute angle-closure crisis (AACC; occluded angle with symptomatic high IOP)
• Plateau iris configuration (any ITC persisting after a patent laser peripheral
iridotomy [LPI]) or syndrome (any ITC persisting after a patent LPI with pressure
elevation after dilation)
(The management of other secondary forms of angle closure (e.g., iris bombé) is
not discussed in this pocket card.)
Î Common risk factors for PAC include Asian descent; hyperopia; older
age; female gender; short axial length; and the size, shape, or position
of the crystalline lens.
• The prevalence of angle closure varies from ≤0.6% in European and European-
derived populations to 3.8% in one study of Alaskan Inuits.
Î The clinical signs and symptoms of AACC include pressure-induced
corneal edema (experienced as blurred vision and occasionally as
multicolored haloes around lights), a mid-dilated pupil, vascular (i.e.,
conjunctival and episcleral) congestion, eye pain, headache, nausea,
and/or vomiting.
Î Dark-room dynamic gonioscopy (as described in the subsection
Gonioscopy in the Diagnosis section) should be performed to
diagnose angle-closure disease and to verify improvement in angle
configuration following treatment.
Î Patients experiencing AACC should receive aqueous suppressants
to lower the IOP acutely and laser iridotomy or iridectomy. After
addressing the episode of AACC, it is important to perform LPI in the
fellow eye when indicated.
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