Acute Primary Angle-Closure Glaucoma: Understanding the Condition and Its Treatment

Acute primary angle-closure glaucoma (APACG) is a type of glaucoma caused by the sudden closure of the angle between the iris and cornea. This closure blocks the flow of aqueous humor, the fluid that nourishes the eye, leading to a rapid increase in intraocular pressure (IOP) and severe eye pain, headache, nausea, and vision loss. If left untreated, APACG can lead to blindness in a matter of hours or days.

Symptoms and Causes of APACG

Symptoms of APACG can include sudden onset of severe eye pain, headache, blurred vision, halos around lights, and nausea. The cause of APACG is related to the anatomy of the eye, specifically a narrow angle between the iris and cornea. This narrow angle can be caused by a variety of factors such as age, hyperopia (farsightedness), and certain types of cataracts.

Diagnosis and Treatment of APACG

APACG is typically diagnosed through a comprehensive eye exam, including measuring the IOP and examining the angle of the eye. The treatment of APACG is urgent and requires immediate medical attention. The goal of treatment is to lower the IOP and protect the optic nerve.

Medical Therapy: The first line of treatment for APACG is medical therapy. Medications such as ocular hypotensive agents, which lower the IOP, can be used to protect the optic nerve. These medications work by reducing the amount of aqueous humor produced by the eye or increasing the outflow of aqueous humor from the eye.

Laser Therapy: Laser therapy such as laser peripheral iridotomy (LPI), which creates a small hole in the iris to allow the aqueous humor to flow more freely, can also be used to lower IOP.

Surgery: In some cases, surgery may be recommended. The most common surgery for APACG is Trabeculectomy, a procedure that creates a new drainage channel for the aqueous humor to flow out of the eye, lowering the IOP.

Monitoring

APACG is a chronic condition that requires regular monitoring to ensure that the treatment plan is effective. The patient will need to have regular eye exams to check the IOP, angle of the eye, and visual field. If the treatment is not effective, the treatment plan may need to be adjusted.

Prevention

While there is no known way to prevent APACG, early detection and treatment can help slow the progression of the disease. It is important to have regular eye exams, especially if you have a family history of glaucoma or other risk factors such as age above 40, hyperopia, or certain types of cataracts.

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