eye disorders
Angle Closure Glaucoma
Diagnosis of Angle Closure Glaucoma
Acute:Measurement of intraocular pressure (IOP) and clinical findings Chronic:Gonioscopy showing peripheral anterior synechiae and characteristic optic nerve and visual field abnormalities Diagnosis of acute angle-closure glaucoma is clinical and by measurement of IOP. Gonioscopy may be difficult to do in the involved eye because of a clouded cornea with friable corneal epithelium. However, examination of the other eye reveals a narrow or occludable angle. If the other eye has a wide angle, a diagnosis other than primary angle-closure glaucoma should be considered. Pupillary block mechanism can be recognized as iris bombe, an anterior bowing or arc of the iris between the angle and the pupil. Diagnosis of chronic angle-closure glaucoma is based on the presence of peripheral anterior synechiae on gonioscopy and characteristic optic nerve and visual field changes (see symptoms and signs of Symptoms and Signs ). Before giving or prescribing mydriatic eye drops (which can trigger acute narrow-angle glaucoma in patients at risk), anterior chamber depth should be assessed. If gonioscopy is unavailable, the chamber depth can be more crudely assessed using a slit lamp or even a penlight; the penlight is held next to the temporal side of the eye, with the light beam parallel to the iris. If a shadow is cast on the nasal iris, the angle is probably narrow, because the temporal iris bows forward and blocks the light. 