Slit-lamp Biomicroscopy
• Conjunctival hyperemia (in acute cases)
• Central and peripheral anterior chamber depth narrowing
• Anterior chamber inflammation suggestive of a recent or current attack
• Corneal swelling. (Microcystic edema and stromal edema are common in acute
cases.)
• Iris abnormalities, including diffuse or focal atrophy, posterior synechiae,
abnormal pupillary function, irregular pupil shape, and a mid-dilated pupil
(suggestive of a recent or current attack)
• Lens changes, including cataract and glaukomflecken (patchy, localized, anterior
subcapsular lens opacities) (see Figures 1 and 2)
• Corneal endothelial cell loss
Gonioscopy
Î Gonioscopy of both eyes should be performed on all patients in whom
angle closure is suspected to evaluate the angle anatomy, presence
of ITC and/or PAS, and plateau iris configuration. Compression
(indentation) gonioscopy with a four-mirror or similar lens is
particularly helpful to determine if visible appositional closure is
actually permanent synechial closure and, if so, the extent of such
PAS.
Î Dark-room gonioscopy and IOP measurements should be performed
pre- and post-dilation to ensure a non-occludable angle following the
LPI. (G, S)
Anterior Segment Imaging
Î Anterior segment imaging should be considered when angle anatomy
is difficult to assess on gonioscopy.
Table 2. Clinical Findings That Define Patients Seen With
Angle-Closure Disease
Primary
Angle-Closure
Suspect
Primary Angle
Closure
Primary
Angle-Closure
Glaucoma
≥180° ITC Present Present Present
Elevated IOP or PAS Absent Present Present
Optic nerve damage Absent Absent Present
3
