Acute angle-closure glaucoma - External and Internal Eye
An attack of acute ACG occurs when there is a sudden obstruction of aqueous humor outflow through the drainage angle of the eye, causing a rapid increase in intraocular pressure (IOP). Primary angle closure may be caused by pupillary block or angle crowding or both. Pupillary block occurs when the increased iris convexity brings the iris into apposition with the trabecular meshwork, thereby blocking drainage of the aqueous fluid. With angle-crowding mechanism, anteriorly positioned ciliary processes push the iris anteriorly so that the peripheral iris lies against the trabecular meshwork. Secondary angle closures are associated with angle blockage from other ocular diseases such as iris neovascularization, uveitis, trauma, tumors, ectopic lens, cataract, or lens protein leakage.
Patients often present with acute onset of extremely painful, decreased vision associated with a red eye and a mid-dilated pupil. Headache, seeing rainbow-colored halos around lights, nausea, and vomiting are also commonly present. There may be a recent history of physiologic (ie, being in a dark room) or pharmacologic pupillary dilation.
H40.219 – Acute angle-closure glaucoma, unspecified eye
30041005 – Acute angle-closure glaucoma
Differential Diagnosis & Pitfalls
- Uveitis / scleritis (eg, nodular, diffuse, necrotizing)
- Keratitis (eg, fungal, bacterial, herpes simplex virus, Lyme, marginal, interstitial)
- Conjunctivitis (viral, allergic)
- Corneal ulcer (eg, bacterial or fungal)
- Aqueous misdirection syndrome (typically seen post-eye surgery), also called malignant glaucoma
- Ocular chemical injury (eg, ocular acid burn, ocular alkali burn)
Drug Reaction Data